Study of Body Mass Index post DIEP Flap Breast Reconstruction: A Patient Perspective
I rely on research from evidence based journals I read to understand and share the latest information about breast reconstruction and breast cancer to the community I serve. One of the journals I utilize is Plastic and Reconstructive Surgery: Journal of the American Society of Plastic Surgeons. January is a month many of us focus on health, weight loss, and losing those extra holiday pounds. As a patient advocate who has had autologous, DIEP flap breast reconstruction, I wanted to share my thoughts and perspective from a study of body mass index post DIEP flap breast reconstruction from the December 2017 issue of the Journal : The Impact of Autologous Breast Reconstruction on Body Mass Index Patterns in Breast Cancer Patients: A Propensity-Matched Analysis.
I appreciate the focus of the article. It can be read here from the final statement in the conclusion of the paper:
Our findings can be used to identify high-risk patients, enhance oncologic risk counseling, and guide targeted weight management strategies to maximize patient survival rates.
The study reviewed breast cancer patients over a two-year period who had a mastectomy and included those undergoing no breast reconstruction and those undergoing autologous (using your own tissue) breast reconstruction. It included a broad range of variables and from my perspective as a patient advocate the variables were comprehensive. One of the challenges of any study is to include as many variables as possible and it was in this particular one. However, those limitations were clearly stated in the Discussion portion of the paper.
The implication of the article is not suggesting having DIEP flap breast reconstruction is a viable “weight loss” mechanism after breast cancer and mastectomy. The study was done to look at trends and make recommendations to include counseling in weight management for breast cancer patients. A conclusion of the study reported women undergoing autologous breast reconstruction did gain less weight after diagnosis than non-reconstruction patients.
There are a variety of factors that cause possible weight gain after a breast cancer diagnosis. The individual response to weight gain and post mastectomy varies from patient to patient. Some of the factors mentioned in the article included:
- Side effects from treatment
- Lack of physical exercise due to fatigue or lifestyle
- Psychosocial and psychological impact of losing your breasts
- Loss of a feeling of femininity due to loss of breasts
- Loss of sexual function post mastectomy and treatment
I believe many patients are keenly aware of the statistics that being overweight is a risk factor for breast cancer or a recurrence. The question and challenge become, how is weight managed after a breast cancer diagnosis? This study is highly suggestive breast cancer patient care should include post diagnosis counsel with a registered dietitian and/or health care coach to encourage healthy food choices, lifestyle changes, and regular exercise to maintain a healthy BMI.
The study suggests improved body image after breast reconstruction may contribute to healthier weight patterns and maintaining a healthier life-style with renewed sense of vitality and body image. This suggestion of improved body image and maintaining a normal, healthy BMI was the case for me after autologous breast reconstruction surgery.
My Body Mass Index post DIEP flap Breast Reconstruction
My personal experience after DIEP flap was that I did lose weight and am now happily maintaining a normal and healthy BMI. This is something I struggled with prior to breast reconstruction. My BMI was just a few pounds over the “normal” category and into the “overweight” category before I had autologous breast reconstruction.
I went to a registered dietitian for counsel on food proportion and nutritional value after my second cancer diagnosis. I spoke with her about a regular exercise routine and attribute part of the success in maintaining my normal BMI to this discussion with the dietitian. I frequent the gym for both aerobic exercise as well as weight training to maintain bone strength. I encourage breast cancer patients to have a weight management discussion with any member of your health care team, whether it is your breast surgeon, primary care physician, oncologist, plastic reconstructive surgeon, or nurse. Ask for resources and referrals. You may have to be your own best advocate and initiate the conversation.
Does Having DIEP flap give you less room for food?
I look at studies through the lens of a patient advocate. I feel as patients, we can add to the conversation, the inquiry, the extension and broadening of studies by giving our input. I personally feel part of my weight loss, albeit only around 12 pounds post DIEP flap surgery, has an added component not mentioned in the study. I simply don’t have the room I used to have in my abdominal area to comfortably accommodate the food I consumed before my breast reconstruction. I like it, too! Talk about my personal weight control management plan!!
A DIEP flap involves taking a fair amount of tummy tissue to make your breasts. The incision made at the top of the tummy is then pulled down to just above the pubic area and sewn down. That tummy tissue along with the underlying blood vessels is then transferred up to the breast area to make your new soft, warm, breasts. The study did mention the “plication” (sewing down of the tissue) but not as a direct implication of weight loss. That is just my own personal observation. I feel that my “tighter abs” are a beneficial side effect of my surgery.
So, is there less volume in the tummy area after autologous breast reconstruction? I think that would be difficult to measure and track data on. However, maybe that will be an observational component that might be tracked in the next study. Until then, I have to say I am a statistical success of a now normal BMI after DIEP flap breast reconstruction.
Has your BMI changed after DIEP flap breast reconstruction? I’d love to hear your feedback. We are all so very different and unique in our Journey!