{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T23:08:01Z","timestamp":1784070481683,"version":"3.55.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Body mass index (BMI) limits of 30.0 to 32.7\u2009kg\/m2 have been recommended to reduce postoperative complications in autologous breast reconstruction. However, BMI does not accurately represent body composition for all individuals. This study evaluates the relationship between abdominal wall thickness (AWT) and postoperative complication rates using a novel, accessible measuring method.<\/jats:p>\n                  <jats:p>A retrospective chart review of 793 patients (1,310 flaps) who underwent deep inferior epigastric perforator (DIEP) flap reconstruction from November 2017 to May 2024 at two medical sites was conducted. Demographics, medical history, operative course, and postoperative complications were reviewed. Subcutaneous AWT was measured on preoperative computed tomography angiogram at four standardized anatomical landmarks. Patients were stratified by BMI (&lt;25, 25\u201330, 30\u201335, and &gt;35) and AWT (&lt;20, 20\u201340, and &gt;40\u2009mm). Statistical analysis was conducted in R.<\/jats:p>\n                  <jats:p>The mean patient age was 50.5 years, and mean BMI was 30.3\u2009kg\/m2. BMI was strongly correlated with AWT (r\u2009=\u20090.68, p\u2009&lt;\u20090.001), and both variables were strong predictors for complication rates (p\u2009&lt;\u20090.001, p&lt;0.001). Stepwise increases in wound dehiscence, infection, and fat necrosis were observed across AWT groups. Receiver operating characteristic analysis identified AWT threshold of 26.3\u2009mm for overall complications. AWT and BMI models demonstrated comparable predictive ability for complication rates. Patients with mismatched BMI and AWT highlighted cases where BMI alone underestimated risk.<\/jats:p>\n                  <jats:p>AWT may serve as a valuable adjunct tool in determining DIEP flap eligibility, particularly for patients with a high BMI and thin abdominal wall, or vice versa.<\/jats:p>","DOI":"10.1055\/a-2905-6837","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T22:58:05Z","timestamp":1782946685000},"source":"Crossref","is-referenced-by-count":0,"title":["Beyond Body Mass Index: Using Abdominal Wall Thickness to Guide Patient Selection for Deep Inferior Epigastric Perforator Flap Breast Reconstruction"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9071-5312","authenticated-orcid":false,"given":"Joyce Xiaoran","family":"Cui","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Zeng","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Lee","family":"Duet","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist, United States","department":["Department of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Tapp","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist, United States","department":["Department of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila K.","family":"Dos Santos","sequence":"additional","affiliation":[{"name":"Medical College of Georgia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Michael","family":"Robinson","sequence":"additional","affiliation":[{"name":"Atrium Health Carolinas Medical Center, United States","department":["Department of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas N.","family":"Steele","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist, United States","department":["Department of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bennett","family":"Calder","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist, United States","department":["Department of Plastic and Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/micr.22407","article-title":"Are patients with low body mass index 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meta-analysis","volume":"76","author":"K T Lee","year":"2016","journal-title":"Ann Plast Surg"},{"issue":"26","key":"ref11","doi-asserted-by":"crossref","first-page":"e4072","DOI":"10.1097\/MD.0000000000004072","article-title":"Is obesity a predisposing factor for free flap failure and complications? Comparison between breast and nonbreast reconstruction: systematic review and meta-analysis","volume":"95","author":"J Y Shin","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1002\/micr.31056","article-title":"Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: a systematic review and meta-analysis","volume":"43","author":"Z Wang","year":"2023","journal-title":"Microsurgery"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1080\/2000656X.2021.1962334","article-title":"Is there any difference in perioperative characteristics or postoperative complications between overweight, normal-weight and obese patients in delayed DIEP reconstructions?","volume":"56","author":"J Palve","year":"2022","journal-title":"J Plast Surg Hand 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Abul","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/SAP.0000000000004478","article-title":"Postoperative outcomes of incisional negative pressure wound therapy in patients undergoing abdominoplasty, horizontal panniculectomy, or harvest of TRAM or DIEP flaps: systematic review and meta-analysis","volume":"95","author":"A Espinosa-de-Los-Monteros","year":"2025","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref34","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1007\/s00268-019-05335-x","article-title":"The efficacy of prophylactic negative pressure wound therapy for closed incisions in breast surgery: a systematic review and meta-analysis","volume":"44","author":"D Cagney","year":"2020","journal-title":"World J Surg"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.bjps.2026.01.027","article-title":"The impact of closed-incision negative-pressure therapy on donor-site outcomes in drainless abdominal free flap breast reconstruction","volume":"114","author":"J Kim","year":"2026","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.bjps.2024.11.054","article-title":"Complications associated with abdominal incisional wound vacuum assisted closure following deep inferior epigastric perforator flap harvest for breast reconstruction: a single institution retrospective study","volume":"103","author":"E Haas","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"}],"container-title":["Journal of Reconstructive 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