Chapter 5 complications. Compared with the recent series by Cheng et al.22 using the perforator surgical procedure with inclusion of zone IV, our study has a high number of FC. This may be explained by the difference in risk‐factor prevalence compared with this study. The clinical relevance of these findings is that zone IV can be safely included in patients with no risk factors. However, in smokers and obese patients the flap perfusion has to be critically assessed and trimmed accordingly. In these patients, complete removal of zones IV and III in combination with a contralateral reduction mammaplasty may be the safest option. In addition, we need to convince our patients with more persuasion to stop smoking well in advance of the surgery. 82
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