{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:55:46Z","timestamp":1789782946695,"version":"4.0.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,7]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Promoted by reports of decreased donor-site morbidity, deep inferior epigastric perforator (DIEP) flaps have gained significant popularity. Increasing body mass index is associated with poor outcomes in breast reconstruction using traditional techniques. The authors aimed to define complications with increasing body mass index among patients undergoing DIEP flap breast reconstruction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A retrospective analysis of 639 DIEP flaps in 418 patients was performed. Patients were stratified into five groups based on body mass index. Data regarding medical comorbidities, adjuvant therapies, timing of reconstruction, active tobacco use, and surgical history were collected. Primary outcomes were compared among groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The average body mass index for the entire population was 28.3 (range, 17 to 42). Increasing body mass index was associated with increased incidence of hypertension, previous abdominal operations, and length of follow-up. Flap complications stratified by group demonstrated significantly increased delayed wound healing complications in severely obese patients compared with lower body mass index groups. Donor-site complications stratified by body mass index demonstrated significantly increased delayed wound healing and overall complications among morbidly obese patients compared with other groups. Incidence of abdominal wall bulging and hernia formation was not significantly different among groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Increasing body mass index predisposes patients to delayed wound healing complications in both flap and donor-site locations. Nevertheless, overall flap complications remain similar across all body mass index groups. Abdominal wall stability was maintained. Given a similar flap complication profile and maintenance of abdominal stability, DIEP flaps are recommended in patients with increased body mass index.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CLINICAL QUESTION\/LEVEL OF EVDENCE:<\/jats:title>\n            <jats:p>Risk, II.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/prs.0b013e3182547d09","type":"journal-article","created":{"date-parts":[[2013,1,2]],"date-time":"2013-01-02T17:38:26Z","timestamp":1357148306000},"page":"21e-33e","source":"Crossref","is-referenced-by-count":87,"title":["Abdominal Wall Stability and Flap Complications after Deep Inferior Epigastric Perforator Flap Breast Reconstruction"],"prefix":"10.1097","volume":"130","author":[{"given":"Oscar","family":"Ochoa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minas","family":"Chrysopoulo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chet","family":"Nastala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Ledoux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Pisano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-9-20231119","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/00006534-198202000-00006","article-title":"Breast reconstruction with a transverse abdominal island flap.","volume":"69","author":"Hartrampf","year":"1982","journal-title":"Plast Reconstr Surg"},{"key":"R2-9-20231119","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/00006534-199506000-00007","article-title":"TRAM flap anatomy correlated with a 10-year clinical experience with 556 patients.","volume":"95","author":"Watterson","year":"1995","journal-title":"Plast Reconstr Surg"},{"key":"R3-9-20231119","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1097\/00006534-199806000-00007","article-title":"A comparison of morbidity from bilateral, unipedicled and unilateral, unipedicled TRAM flap breast reconstructions.","volume":"101","author":"Paige","year":"1998","journal-title":"Plast Reconstr Surg"},{"key":"R4-9-20231119","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0094-1298(20)31796-X","article-title":"Complications of breast reconstruction.","volume":"11","author":"Scheflan","year":"1984","journal-title":"Clin Plast Surg"},{"key":"R5-9-20231119","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/00000658-198705000-00009","article-title":"Autogenous tissue reconstruction in the mastectomy patient: A critical review of 300 patients.","volume":"205","author":"Hartrampf","year":"1987","journal-title":"Ann Surg"},{"key":"R6-9-20231119","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/00000637-198301000-00005","article-title":"The transverse abdominal island flap: Part I. Indications, contraindications, results, and complications.","volume":"10","author":"Scheflan","year":"1983","journal-title":"Ann Plast Surg"},{"key":"R7-9-20231119","first-page":"423","article-title":"The free abdominoplasty flap and its use in breast reconstruction: An experimental study and clinical case report.","volume":"13","author":"Holmstrom","year":"1979","journal-title":"Scand J Plast Reconstr Surg"},{"key":"R9-9-20231119","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/00006534-200201000-00016","article-title":"Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: The role of muscle preservation.","volume":"109","author":"Nahabedian","year":"2002","journal-title":"Plast Reconstr Surg"},{"key":"R10-9-20231119","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1097\/00006534-200206000-00015","article-title":"Complications in postmastectomy breast reconstruction: Two-year results of the Michigan Breast Reconstruction Outcome Study.","volume":"109","author":"Alderman","year":"2002","journal-title":"Plast Reconstr Surg"},{"key":"R11-9-20231119","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1097\/00006534-200004050-00007","article-title":". Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction.","volume":"105","author":"Chang","year":"2000","journal-title":"Plast Reconstr Surg"},{"key":"R12-9-20231119","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/S0007-1226(97)90540-3","article-title":". The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.","volume":"50","author":"Blondeel","year":"1997","journal-title":"Br J Plast Surg"},{"key":"R13-9-20231119","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/00006534-200009010-00008","article-title":"Fat necrosis in free transverse rectus abdominis myocutaneous and deep epigastric perforator flaps.","volume":"106","author":"Kroll","year":"2000","journal-title":"Plast Reconstr Surg"},{"key":"R14-9-20231119","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1080\/02844310500296016","article-title":"Ten years experience of free flaps for breast reconstruction in a Danish microsurgical center: An audit.","volume":"40","author":"Bonde","year":"2006","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"key":"R15-9-20231119","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/01.sap.0000201549.83738.42","article-title":"Complications associated with breast reconstruction using a perforator flap compared with a free TRAM flap.","volume":"56","author":"Sheer","year":"2006","journal-title":"Ann Plast Surg"},{"key":"R16-9-20231119","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/PRS.0b013e31818b7533","article-title":"Abdominal wall following free TRAM or DIEP flap reconstruction: A meta-analysis and critical review.","volume":"124","author":"Man","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"R18-9-20231119","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1097\/01.prs.0000252003.14537.d2","article-title":"Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction.","volume":"119","author":"Spear","year":"2007","journal-title":"Plast Reconstr Surg"},{"key":"R19-9-20231119","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1097\/01.PRS.0000110328.47206.50","article-title":". A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.","volume":"113","author":"Gill","year":"2004","journal-title":"Plast Reconstr Surg"},{"key":"R20-9-20231119","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1001\/jama.2009.2014","article-title":"Prevalence and trends in obesity among US adults, 1999-2008.","volume":"303","author":"Flegal","year":"2010","journal-title":"JAMA"},{"key":"R21-9-20231119","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.bjps.2007.06.028","article-title":". Bilateral breast reconstruction with DIEP flaps: 4 years experience.","volume":"61","author":"Drazan","year":"2008","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"R22-9-20231119","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/PRS.0b013e3181c49770","article-title":"The deep inferior epigastric perforator flap: Myth and reality.","volume":"125","author":"Selber","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"R23-9-20231119","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/PRS.0b013e3181774267","article-title":"True incidence of all complications following immediate and delayed breast reconstruction.","volume":"122","author":"Sullivan","year":"2008","journal-title":"Plast Reconstr Surg"},{"key":"R24-9-20231119","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1097\/PRS.0b013e318205f255","article-title":"Morbidity of microsurgical breast reconstruction in patients with comorbid conditions.","volume":"127","author":"Seidenstuecker","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"R25-9-20231119","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1097\/01.prs.0000288014.76151.f7","article-title":". Immediate postoperative complications in DIEP versus freemuscle-sparing TRAM flaps.","volume":"120","author":"Chen","year":"2007","journal-title":"Plast Reconstr Surg"},{"key":"R27-9-20231119","first-page":"1527","article-title":"DIEP flaps in women with abdominal scars: Are complication rates affected Plast Reconstr Surg.","volume":"121","author":"Parrett","year":"2008","journal-title":""},{"key":"R29-9-20231119","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1097\/PRS.0b013e31816b1458","article-title":"Risk factors for abdominal donor-site morbidity in free flap breast reconstruction.","volume":"121","author":"Vyas","year":"2008","journal-title":"Plast Reconstr Surg"},{"key":"R30-9-20231119","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/01.PRS.0000149588.09148.53","article-title":"The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients.","volume":"115","author":"Garvey","year":"2005","journal-title":"Plast Reconstr Surg"}],"container-title":["Plastic &amp; Reconstructive Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00006534-201207000-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T20:02:29Z","timestamp":1700424149000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00006534-201207000-00009"}},"subtitle":["Does Body Mass Index Make a Difference? Analysis of 418 Patients and 639 Flaps"],"short-title":[],"issued":{"date-parts":[[2012,7]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2012]]}},"URL":"https:\/\/doi.org\/10.1097\/prs.0b013e3182547d09","relation":{},"ISSN":["0032-1052"],"issn-type":[{"value":"0032-1052","type":"print"}],"subject":[],"published":{"date-parts":[[2012,7]]}}}