The below question is answered by Richard M. Kline Jr., M.D. of The Center for Natural Breast Reconstruction
I’ve read that women who are overweight are better candidates for DIEP flaps since they have “extra” to use, what is your opinion?
Many women with high BMIs (exceeding 40) have enjoyed successful flap reconstructions; however, they are at significantly higher risk of developing post operative complications.
It is well-demonstrated in the plastic surgery literature, that people with a significantly higher BMI are far more likely to experience complications than those with a lower BMI. There is no magical “line-in-the-sand” cut-off point, though—many factors, such as proportion of fat, which is intra-abdominal (vs. subcutaneous, which is what can be used in a flap), undoubtedly play a role in determining each person’s risk. Besides wound-healing problems, increased BMI also increases the risk for blood clots, which can, of course, be lethal.
Some lay-posters on blogs have stated that you shouldn’t worry about blood clots because injectable blood thinners will prevent them. This is a VERY DANGEROUS misconception—blood thinners only REDUCE the incidence of blood clots, and nothing can completely prevent them in all patients. We feel that it is your surgeon’s duty to you to assess your individual risks, and propose a plan that will get you through the surgery as safely as possible. Other surgeons, and other patients, may feel differently.
Our practice has demonstrated that it IS possible to have an outstanding safety record, while simultaneously maintaining a high reconstruction success rate. My personal flap survival rate over the last 10 years exceeds 99%, and the overwhelming majority of our patients are pleased that they went through the procedure at our facility. Our primary goal, however, is not to try and push limits by seeing what we can “get away with” in higher-risk patients. Instead, we strive to give everyone the best possible Natural Breast Reconstruction with perforator flaps, while at the same time doing everything possible to ensure their safety.
—Richard M. Kline Jr., M.D.
The Center for Natural Breast Reconstruction