Patients often ask how much fat is needed for DIEP flap breast reconstruction surgery. Although there is no textbook fat requirement for DIEP flap surgery, there are three factors to consider when answering the question—BMI, how an individual’s weight is distributed, and final result expectations. The amount of fat needed to perform a successful DIEP procedure will vary based on an individual’s needs.

Let’s break down the three common factors considered when discussing the amount of fat needed for DIEP flap surgery…

What is the necessary BMI for DIEP flap surgery?

BMI (or Body Mass Index) is a measure of body fat based on an individual’s height and weight. There is no “perfect BMI” for patients seeking DIEP surgery, but there are some BMI restrictions. Patients with high BMI’s are at an increased risk of complications following any surgery, including breast reconstruction. The most common complication associated with higher BMI and DIEP flap is wound healing. At PRMA, we require our patients to have a BMI of under 40 before being eligible for surgery.

Patients with low BMI’s (20 and below) are often told from other breast centers that they are not candidates for surgery. However, this is not necessarily the case. At PRMA we regularly perform successful DIEP flap surgery on patients with a low BMI as long as their weight distribution is primarily in their lower abdominal region.

How Does Weight Distribution Factor Into DIEP Flap Surgery?

In patients with low BMIs, weight distribution is key in determining whether or not there is enough fat for a successful surgery. Thinner women are eligible for DIEP surgery if they carry enough fat in their lower tummy region.

The best way to gauge whether you may have enough lower abdominal fat is to perform a “pinch test.” While in the standing position, bend slightly at the waist. Using your fingers, pinch the lower abdominal tissue (from just under your belly button to right above your pubic hairline). The amount of tissue you can pinch is close to the same amount a surgeon will be able to use to recreate one or both breasts. Please remember, the pinch test is just an estimate, and your surgeon will be able to give you a more accurate assessment.

Even if a patient has a smaller amount of lower abdominal fat, DIEP flap is still possible as long as the predicted breast size result is in line with the final result expectations from the patient.

Why are Patient Final Result Expectations Important?

When determining whether or not a patient has enough fat to perform DIEP flap reconstruction, discussing final result expectations play a huge role. It is essential that a patient has enough fat to achieve their desired breast size. Some patients may be candidates for surgery, but their lower abdominal tissue may not be enough to achieve their desired breast size. In these cases, there are a few options for patients. These include weight gain prior to surgery, fat grafting during the second stage of reconstruction, or adding a small implant during a separate procedure.

Regardless of what a patient weighs, if they are interested in DIEP flap reconstruction, we strongly advise scheduling a virtual consultation with one of our board-certified plastic surgeons to determine if they are a good candidate for the surgery.