Related Experiment Video
Updated: Aug 6, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Deep Inferior Epigastric Perforator Flap Reconstruction Outcomes Across Body Mass Index Categories: A Retrospective
Caterina M Nava1, Gauthier Zinner1, Mathias Tremp2,3
1From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland.
Background:
The impact of body mass index (BMI) on outcomes following deep inferior epigastric perforator (DIEP) flap breast reconstruction remains debated. Although obesity is a well-known risk factor for surgical complications, limited evidence exists on the safety of the DIEP flap across different BMI populations.
Methods:
We conducted a retrospective study of 117 patients (144 flaps) who underwent DIEP flap breast reconstruction between January 2018 and August 2024. Patients were stratified into 3 BMI groups according to the World Health Organization classification: normal weight, 18.5-25 kg/m2; overweight, 25-29.9 kg/m2; and obese, 30 kg/m2 or higher. Preoperative, intraoperative, and postoperative data were collected.
Results:
Complication rates were generally low across BMI groups. Abdominal seroma (P = 0.038) occurred significantly more often in patients with a BMI 30 kg/m2 or higher. Fat necrosis and total flap loss occurred exclusively in the obese group, with rates of 7.1% in each, and both findings approached statistical significance (P = 0.056). No significant differences were observed in rates of infection, wound dehiscence, hernia, or flap loss. Hospital stays increased with BMI; each unit increase in BMI was associated with a 0.20-day extension (P = 0.006). BMI was not an independent predictor of postoperative donor-site, recipient-site, or flap complications.
Conclusions:
DIEP flap reconstruction is a safe option for class I and II obese patients. Although higher BMI is associated with increased rates of abdominal seroma and longer hospital stays, overall complication rates remain acceptable. BMI alone should not be considered a contraindication for autologous breast reconstruction in non-morbidly obese patients.
