DIEP flap surgery is a breast reconstruction procedure that uses tissue from the lower abdomen. As with many procedures that use an area of the body as a donor site for tissue to be moved to another area, weight distribution is commonly a factor that needs to be considered.
In this blog, we’ll break down how weight can impact DIEP flap surgery, what your surgeon may need to consider, and what patients might expect if weight loss is suggested before moving forward.
While learning about how weight is considered can be helpful, it’s always important to refer to your personalised advice, as given by your surgeon. If you are considering undergoing this procedure, we recommend discussing your situation with Specialist Plastic and Reconstructive Surgeon A/Prof Bish Soliman during a detailed consultation.
Why does weight matter when it comes to DIEP flap surgery?
The DIEP flap technique involves taking skin and fat from the abdomen while preserving the abdominal muscles. For this reason, the amount of available abdominal fat and the overall condition of the tissues are important. Patients who carry more abdominal fat may technically have more tissue for the reconstruction, but this may also come with an increased surgical risk.
A higher body weight may affect how wounds heal, increase the risk of infection, and make anaesthesia more complex. On the other hand, patients with very little abdominal tissue may not have enough fat to allow for an adequate flap, which could also complicate the surgery. This is why surgeons often look for a balance, which means having enough tissue to allow for a reconstruction, but not so much that it can raise the likelihood of encountering complications.
How is BMI considered before the procedure?
Body mass index (BMI) is often used as a general guide, though it’s not the only factor surgeons take into account. A BMI that is significantly above the healthy range may be associated with longer surgery times, higher risk of wound breakdown, and a more difficult recovery. Some surgeons may set a BMI threshold, asking patients to reach a particular target before proceeding.
It’s important that BMI is only part of the picture. Muscle mass, fat distribution, and overall health can make the same BMI mean very different things for different patients. This is why consultations are tailored individually rather than based on a strict number alone.
Are there any risks associated with being at a higher weight?
When considering DIEP flap surgery, surgeons will often explain the risks that can be elevated at higher weights. Wound healing is one of the most significant concerns, as the abdominal incision is extensive and can take longer to close in patients with more tissue tension. There is also a greater likelihood of seroma (fluid build-up), delayed healing, or wound separation.
Another risk factor is related to the blood supply. Since the success of a DIEP flap depends on the transplanted tissue receiving a healthy blood flow, surgeons carefully map out blood vessels during the procedure. Extra abdominal fat can make this more technically challenging, and in some cases, the vessels may be more difficult to work with. Please also state that there is an increased risk of fat necrosis
From an anaesthesia perspective, higher weight can also place additional strain on the heart and lungs during surgery, which is another factor that may make surgeons cautious when planning the operation.
However, the patient’s actual weight will influence all of these factors – not all patients who are overweight may face the same risks, so it’s important to discuss risks during your consultation process.
When may weight loss be suggested?
If a patient has a BMI that is outside the range most surgeons are comfortable operating within, weight loss may be advised before DIEP flap surgery is performed.
Please look at the literature – i think if bmi >32 then complications increase
Weight loss that is steady and sustainable is generally the approach that surgeons prefer to see. Rapid or extreme dieting can affect skin quality and healing ability, which is typically not desired before a surgery that depends heavily on good tissue health.
Weight should also ideally be stable for a period before surgery. Large changes in weight after DIEP flap surgery could affect the reconstructed breast or abdominal donor site, so maintaining a consistent weight before and after the operation is considered important.
Are there any risks of losing too much weight before the surgery?
While excess weight can increase risk, losing too much can also create problems.
If abdominal fat becomes too limited, there may not be enough donor tissue to reconstruct the breast to a suitable size. In these situations, surgeons might discuss alternative flap options, such as using tissue from the thighs or buttocks, but these procedures can be more complex.
This balance between having enough donor tissue and maintaining a weight that minimises surgical risk is why individual assessment is so central to the planning stage.
What can I expect during my consultation process?
During your consultation, your surgeon will perform a physical assessment, discuss your medical history, and may sometimes order scans to evaluate your abdominal vessels.
They will also talk about your current weight and whether it could affect the surgery. If weight loss is recommended, it will usually be presented as part of a broader discussion about reducing risks and supporting recovery.
You may also be advised to stop smoking (you cant smoke 6 weeks before and after – this is a non negotiable), improve your diet, and ensure you’re physically active, as these lifestyle changes can make a significant difference to how your body heals after an operation of this scale.
Overall, your consultation will be entirely focused on your needs as an individual, and on making sure that the procedure can meet your needs.
Why to choose Specialist Plastic and Reconstructive Surgeon A/Prof Bish Soliman for a DIEP Flap Breast Reconstruction in Sydney
If you are considering DIEP flap surgery, it’s always best to speak directly with a surgeon who can assess your individual needs and guide you through the process.
You can also say that I have been involved in more than 500 DIEP’s
Highly trained and experienced surgeons, particularly those who have trained in reconstructive procedures, will have the skillset to provide you with the right support and advice throughout your journey.
As a Specialist Plastic and Reconstructive Surgeon, A/Prof Bish Soliman has undergone extensive training to specialise in complex microsurgical reconstruction, as well as aesthetic surgery of the breast, body and face.
To speak to A/Prof Bish about your specific surgical needs, we invite you to get in touch with our team so that we can assist in scheduling your consultation. You are also welcome to contact us with any questions you may have about the procedure.
Read more about DIEP Flap Surgery from A/Prof Bish Soliman:
- A/Prof Bish’s breast reconstruction procedure page
- A/Prof Bish’s blog: What can you expect from DIEP Flap breast reconstruction?
- A/Prof Bish’s blog: How to recover from DIEP breast reconstruction?
- A/Prof Bish’s blog: What are my options for breast reconstruction?
- A/Prof Bish’s blog: How much does breast reconstruction cost in Australia?
- A/Prof Bish’s blog: Will Medicare cover my DIEP breast reconstruction surgery?
- A/Prof Bish’s blog: Who are the best DIEP breast reconstruction surgeons in the World?
- A/Prof Bish’s blog: Why A/Prof Soliman prefers a DIEP breast reconstruction?
- A/Prof Bish’s blog: How and when to resume arm exercises after DIEP Breast Reconstruction?
Medical references about DIEP Flap breast reconstruction:
