Superficial Inferior Epigastric Vessel Caliber and Reliability in the Massive Weight Loss Population: Implications for Breast Reconstruction
Jeffrey A. Gusenoff, MD, Devin Coon, B.A., Carolyn De La Cruz, MD, J. Peter Rubin, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
Breast cancer risk and reconstructive options after massive weight loss (MWL) are undefined. Utilization of the resulting pannus for autologous reconstruction is possible, with one option being the superficial inferior epigastric artery (SIEA) flap. Large SIE vessels have been observed in MWL patients during abdominal contouring procedures but their anatomical features have not been assessed.
METHODS: 32 consecutive MWL patients undergoing abdominal contouring had their SIE vessels measured intraoperatively to assess correlation with BMI indices and pannus weight using appropriate statistical analyses.
RESULTS: 64 hemi-abdomens were assessed. Mean age was 46 ± 9.8 years. Mean MaxBMI was 49.5 ± 8.3, CurrentBMI was 29.6 ± 6.0, and ΔBMI was 19.9 ± 5.6 with a mean pannus weight of 3338.4 grams. Mean artery size was 1.7mm and mean vein size was 2.9mm. 32/62 (52%) of hemi-abdomens had a usable vessel (≥1.5mm). MaxBMI was related to the overall presence of an SIEA (p=0.009) or usable artery (p=0.04) while both CurrentBMI and MaxBMI were related to SIEV size (p<0.001). Pannus weight was correlated to SIEV size, SIEA size, CurrentBMI and MaxBMI (p<0.001). Pannus weight was also strongly correlated to CurrentBMI (R=0.78) and MaxBMI (R=0.46).
The SIE vessel system is commonly present in MWL patients. BMI prior to weight loss is the strongest predictor of SIEA presence and usability. When MWL 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.