Deep Inferior Epigastric Perforator Flap Reconstruction Outcomes Across Body Mass Index Categories: A Retrospective Study

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/m 2 ; overweight, 25–29.9 kg/m 2 ; and obese, 30 kg/m 2 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/m 2 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.