Perioperative vitamin D insufficiency impacts postoperative outcomes in abdominally based breast reconstruction

Authors: Aryanpour Z, Cronin JE, Shah A, Yang JH, Haas EJ, Winocour J, Kaoutzanis C, Mathes DW, Egan KG

Affiliation: University of Colorado Anschutz Medical Campus

Journal: Plastic and Reconstructive Surgery, April 2026

PMID: 41051269

Key takeaways

• Vitamin D insufficiency was common, affecting 40.8% of DIEP flap patients.

• 25-hydroxyvitamin D insufficiency was independently associated with surgical-site infection, donor-site seroma, and medical complications.

• The association persisted after adjustment for BMI, albumin, supplementation, operative time, and reconstruction timing/laterality.

• Vitamin D testing and supplementation may identify a low-cost, modifiable risk factor before abdominally based breast reconstruction.

Background

Vitamin D (25-OHD) insufficiency is increasing globally and estimated to be as high as 40% in the general population and even higher in the cancer population. Vitamin D is biologically plausible as a wound-healing factor because it influences immune function, inflammation, angiogenesis, and cellular differentiation. This study evaluates whether perioperative vitamin D insufficiency is associated with postoperative complications after DIEP flaps.

Methods

• Design: Single-institution retrospective cohort study, 2015–2023

• Population: 147 patients undergoing DIEP flap autologous breast reconstruction with perioperative 25-OHD testing within 3 months of surgery.

  • Vitamin D insufficient: <30 ng/mL; n = 60

  • Vitamin D sufficient ≥30 ng/mL; n = 87

• Outcomes: Return to OR, readmission, flap loss, surgical-site infection, donor-site seroma, recipient-site infection, delayed wound healing, fat necrosis, mastectomy flap necrosis, medical complications.

• Statistics: Univariate analysis and multivariable logistic regression adjusting for albumin, supplementation, BMI, operative time, reconstruction timing, and laterality.

Results

• Mean age 51 years old; BMI 29.6 kg/m²;

• 60 patients (40.8%) were vitamin D insufficient. Albumin was similar between groups.

• Vitamin D insufficient patients more likely to undergo bilateral reconstruction (83.3% vs 64.4%) and immediate reconstruction (51.7% vs 24.1%).

• Vitamin D insufficiency was associated with surgical-site infection (OR 2.86; P = 0.04), donor-site seroma (OR 13.23; P < 0.01), and medical complications (OR 4.05; P = 0.02) in univariate analysis.

• On multivariate analysis, vitamin D insufficiency remained independently associated with surgical site infection (OR 4.63, p=0.02), recipient site infection (OR 5.88, p=0.02), donor-site seroma (OR 15.96, p=0.02), and medical complications (OR 6.51, p<0.01)

• Patients taking perioperative vitamin D had higher 25-OHD levels, but supplementation was not shown to reduce complications in this retrospective cohort.

Conclusion

Perioperative vitamin D insufficiency was independently associated with higher surgical-site infection, recipient-site infection, donor-site seroma, and medical complication risk after DIEP flap breast reconstruction. Vitamin D status may represent a simple, low-cost optimization target, but prospective studies are needed to prove that screening and supplementation improve outcomes.