BMI Changes Associated with DIEP Flap Breast Reconstruction

Abstract As patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction frequently anticipate improved abdominal contour, they may also expect a degree of meaningful weight loss. This study aims to clarify whether patients undergoing mastectomy with DIEP flap breast reconstruction experience a significant and durable change in body mass index (BMI). A single-institution, retrospective cohort study was performed on patients who underwent DIEP flap breast reconstruction between 2020 and 2021. Patients were included if they had BMI data available from ≤ 3 months before mastectomy until ≥ 2 years after reconstruction. Every BMI data point within this timeframe was captured. Longitudinal BMI trends were analyzed using a mixed-effects model for the overall cohort and for subgroups of patients with immediate or delayed breast reconstruction. A total of 143 patients (median age at reconstruction, 51.6 years) were included. Most patients (55.5%) underwent unilateral mastectomy and reconstruction. The mean mastectomy tissue masses were 640.8 g (SD 260.9) and 1,363.5 g (SD 713.9) for unilateral and bilateral cases, respectively. In the overall cohort and delayed reconstruction subgroup, there were no significant changes in BMI between pre-mastectomy and post-reconstruction periods. In contrast, patients with immediate reconstruction experienced a BMI decrease of 0.445 kg/m2 between pre-procedure and post-procedure periods (p = 0.023), corresponding to a weight loss of 2.70 lbs. In a cohort of 143 patients, we did not find evidence of clinically significant BMI change associated with mastectomy and DIEP flap breast reconstruction. These results may improve the comprehensiveness and clarity of perioperative counseling, ensuring patients formulate evidence-based reconstructive preferences.