Abstract
Background In patients with a low body mass index (BMI), the options for autologous breast reconstruction
are limited. With the hypothesis that adipose tissue deposition favors the lumbar
region over the abdominal wall, this study sought to investigate the lumbar artery
perforator (LAP) flap as an alternative reconstructive option in patients with deficient
autologous donor sites consequent to a low BMI.
Methods A retrospective cohort analysis was performed, from a prospectively maintained database,
of all consecutive deep inferior epigastric artery perforator flap breast reconstructions
performed in our unit. A randomized selection of 100 patients with low BMI < 22, normal
BMI 22 to 24, and high BMI > 30 was performed. Patient computerized tomography scans
were analyzed to measure abdominal wall and lumbar tissue thickness and to define
anatomical landmark relations of the LAP.
Results A statistically significant difference was identified between the ratio of lumbar-to-abdominal
wall thickness between BMI groups, highlighting preservation of the lumbar thickness
in patients with low BMI. The mean distance at which the fourth lumbar perforator
entered the subcutaneous tissues was 7.7 cm lateral to the spinous process (range
6.4–9.5 cm), with no significant difference between BMI groups, highlighting this
consistent anatomical position.
Conclusion This study confirms a greater lumbar-to-abdominal wall thickness, therefore volume,
in low BMI patients, with consistent lumbar perforator anatomy of 6.4 to 9.5 cm lateral
to the spinous process. The LAP flap should therefore be strongly considered for autologous
breast reconstruction in this patient cohort.
Keywords lumbar artery perforator free flap - low BMI - autologous reconstruction
