Comprehensive Analysis of Donor-Site Morbidity in Abdominally Based Free Flap Breast Reconstruction

Abstract

Therapeutic, III.

The DIEP flap breast reconstruction: Starting from scratch in a university hospital

“…4). A comparison between the first 55 unilateral DIEP flaps (group A) and the 55 following reconstructions (group B) showed similar results ( (1)(2)(3) at the end of the series (groups 4-5; P = 0.021) ( Table 4). This increase was also observed for the entire group, with significant differences observed in groups 1 to 5 (P = 0.014) ( Table 3) and in groups A to B (P = 0.019) ( Table 5).…”

“…The mean ischemic duration was 33 minutes . The number of perforators used to perfuse the flap tissue was 1.62 (1)(2)(3)(4), and the length of the vascular pedicle measured 13.4 cm (9-18.5 cm). The general complication rate was 24.5%, with one or several occurrences per patient.…”

“…The deep inferior epigastric perforator (DIEP) flap represents one of the most advanced procedures for breast reconstruction because of the minimization of donor site morbidity [1] and leads to a high level of satisfaction [2]. However, perforator abdominal flap harvesting and microsurgical anastomosis are technically demanding procedures.…”

Cost-Effectiveness Analysis of Implants versus Autologous Perforator Flaps Using the BREAST-Q

“…A decision tree model was developed, including relative probabilities for successful surgery versus complications for unilateral and bilateral reconstructions without radiation therapy, following a literature review. [16][17][18][19][20][21] For bilateral DIEP flaps, complication rates specifically reported in the medical literature (e.g., hernia and total flap loss) were used. Complications in bilateral implant reconstruction were considered independent events and thus probabilities were added.…”

Challenging a Traditional Paradigm

“…The majority of patients (62.7 percent) also had a revision to the reconstructed breast to optimize their reconstructive outcomes, which was comparable to 64.4 percent of our 1120 potential risks with free flap reconstruction in these patients. 12 As all patients require irradiation, we would recommend performing delayed reconstruction a minimum of 6 months after irradiation to minimize complications and radiation damage to the flap. To our knowledge, only one prior study has specifically examined breast reconstruction for inflammatory breast cancer patients and demonstrated promising results; however, the study was limited by small numbers and poor overall survival.…”