A 10 Year Retrospective Review of 758 DIEP Flaps for Breast Reconstruction
Paul S. Gill, M.D., John P. Hunt, M.D., M.P.H., Aldo B. Guerra, M.D., Frank J. Dellacroce, M.D., Scott K. Sullivan, M.D., Jonathan Boraski, M.D., Stephen E. Metzinger, M.D., Charles L. Dupin, M.D., Robert J. Allen, M.D.
New Orleans, LA
Abstract This study examines 758 Deep Inferior Epigastric Perforator (DIEP) flaps for breast reconstruction in respect to risk factors and associated complications. Risk factors that showed significant association with any breast or abdominal complication included smoking (p=0.0000), post-reconstruction radiation (p=0.0000), and hypertension (p=0.0370). Ninety eight flaps (12.9%) developed fat necrosis. Associated risk factors were smoking (p=0.0226) and post-reconstruction radiation (p=0.0000). Interestingly, as the number of perforators increased, so did the incidence of fat necrosis. There were only 19 cases (2.5%) of partial flap loss and four cases of total flap loss (0.5%). Fourty-five flaps (5.9%) were returned to the operating room prior to the secondary stage procedure. Twenty-five flaps (3.8%) were returned to the operating room for venous congestion. Venous congestion and any complication were found to be statistically unrelated to the number of venous anastomoses. Overall postoperative abdominal hernia or bulge occurred in only five patients (0.6%). Complication rates in our large series are comparable to the retrospective reviews of both the pedicle and free Transverse Rectus Abdominis Myocutaneous (TRAM) flaps.1-8 Previous studies of the free TRAM describe breast complication rates from 8 to 13%, and abdominal complications ranging from 0 to 82%.9-24 In addition we have found that with experience in microsurgical technique and perforator selection, the DIEP flap offers a distinctive advantage to the patient in terms of decreased donor site morbidity and shorter recovery period.25-31 Mastery of this flap provides the reconstructive surgeon more extensive options in the management of the post-mastectomy patient.