4. Impact Of DIEP Flap Weight on Post-operative Complications in Autologous Breast Reconstruction: A Multi-institutional Analysis

PURPOSE: The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. However, post-operative complications vary with reported rates ranging from 15.5 to 47.4%. There is growing interest to identify risk factors that predict complications. Flap weight is one variable in particular that may be associated with tissue necrosis and flap loss. This study investigates the relationship between DIEP flap weight and post-operative complications using a DIEP-specific database. METHODS: A retrospective chart review of 757 patients (757 flaps) with a history of breast cancer who underwent DIEP flap reconstruction from 2017-2024 at two medical institutions. Demographics, medical history, operative course, and post-operative complications were analyzed. RESULTS: BMI was strongly correlated with flap weight (r = 0.79), and both BMI and flap weight were significant predictors of complication rates (p < 0.001, p < 0.001). Patients were grouped by BMI (<25, 25-30, 30-35, and >35) and subsequently into those with and without complications. Logistic regression revealed that flap weight was a significant predictor for wound dehiscence, fat necrosis, and seroma in the BMI 30-35 group, and hematoma for the BMI 25-30 group. Threshold flap weight was 752.19 grams. CONCLUSION: There exists an interesting relationship between DIEP flap weight and complications. Flaps over 752.19 grams may increase complication risks, underscoring the importance of a more tailored approach intraoperatively to enhance patient outcomes.