Superficial inferior epigastric vessels in the massive weight loss population: implications for breast reconstruction

Breast cancer risk and reconstructive options after massive weight loss are undefined. Use of the resulting pannus for autologous reconstruction is possible, with one option being the superficial inferior epigastric artery (SIEA) flap. Large superficial inferior epigastric vessels have been observed in massive weight loss patients during abdominal contouring procedures, but their anatomical features have not been assessed.

Thirty-two consecutive massive weight loss patients undergoing abdominal contouring had their superficial inferior epigastric vessels measured intraoperatively to assess correlation with body mass indices and pannus weight using appropriate statistical analyses.

Sixty-four hemiabdomens were assessed. Mean age was 46 +/- 9.8 years. Mean maximum body mass index was 49.5 +/- 8.3, current body mass index was 29.6 +/- 6.0, change in body mass index was 19.9 +/- 5.6, and mean pannus weight was 3338.4 g. Mean artery size was 1.7 mm and mean vein size was 2.9 mm. Thirty-two of 62 hemiabdomens (52 percent) had a usable vessel (>or=1.5 mm). Maximum body mass index was related to the overall presence of a SIEA (p = 0.009) or usable artery (p = 0.04), whereas both current body mass index and maximum body mass index were related to superficial inferior epigastric vein size (p < 0.001). Pannus weight was correlated to superficial inferior epigastric vein and SIEA size (p < 0.001) and strongly correlated to current body mass index (r = 0.78) and maximum body mass index (r = 0.46).

The superficial inferior epigastric vessel system is commonly present in massive weight loss patients. Body mass index before weight loss is the strongest predictor of SIEA presence and usability. When massive weight loss patients present for breast reconstruction, careful patient selection along with weight loss history and assessment of pannus size may aid in determining the likelihood of using the SIEA flap.