Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps—A Comparative Cohort Study

Abstract

Background: Understanding of donor site morbidity and satisfaction after breast reconstruction is limited. There are few previous studies comparing satisfaction with different donor sites in breast reconstruction. This study aimed to examine the long-term patient-reported satisfaction with the donor site of latissimus dorsi (LD) flaps in comparison to the deep inferior epigastric artery perforator (DIEP) flaps. Further, a systematic review of previously published studies was conducted. Methods: In this retrospective cross-sectional study, all women who underwent breast reconstructions with either LD or DIEP flap following mastectomy and radiotherapy between 2007-2017 were included; patient-reported satisfaction was assessed using the BREAST-Q reconstruction module. For the systematic review, studies examining patient-reported abdominal satisfaction and well-being, and meeting the PICO (Population, Intervention, Comparison, and Outcome) criteria were included. Results: : Eligible and responding participants were divided into the LD (n=135 patients) and DIEP (n=118 patients) flap groups. Impairment due to muscular weakness of the donor site was more common in the LD group than that of the DIEP group. Bulging was common in the DIEP group and increased over time. Regarding the esthetic appearance of the donor site, the patients in the DIEP group were less satisfied than the LD group. The systematic review showed that most of the patients were dissatisfied with their abdomen after the operation. Conclusion: Patients who have undergone DIEP flap for breast reconstruction are less satisfied with the donor site esthetics than those who have undergone LD flap. Patient-reported abdominal bulging was common in the DIEP group and the number seemed to increase over time. Most patients were not satisfied with their abdominal scarring postoperatively, as per the systematic review. These results may indicate a need for more nuanced preoperative patient information, as well as improvements in the surgical management of the donor site, for DIEP flap reconstructions.

A Machine Learning Approach to Predicting Donor Site Complications Following DIEP Flap Harvest

“…Prior literature found latissimus dorsi flaps to be a superior alternative to DIEP flaps in reducing the incidence of bulging after surgery. 25 However, we did not observe any cases of bulging postoperatively. We routinely perform plication to both strengthen the abdominal wall and concurrent ventral hernia repair is performed if present.…”

Patient-Reported Abdominal Morbidity Following Abdomen-Based Breast Reconstruction

“…Preoperative PRO values and longitudinal design with additional surveys in follow-up may support the possibility that bulge does not diminish abdominal well-being. It is possible that abdominal bulge and subsequent abdominal well-being may worsen over time, as documented in the literature 30 ; future studies would benefit from longer follow-up and successive surveys. Finally, objective assessment of muscle strength (force of abdominal contraction and strength challenges) would be useful to characterize the impact of abdominal morbidity on core function.…”

Second-stage Reverse Abdominoplasty after Goldilocks Mastectomy: A Safe Autologous Reconstructive Option in Obese Patients

“…The RA often improves upper abdominal contour with minimal additional scarring after Wise-pattern GM in contrast to the scarring after abdominal microvascular reconstructions, which may result in decreased patient satisfaction. 9 [ See figure, Supplemental Digital Content 1, which displays a 44-year-old obese (BMI = 43.2 kg/m 2 ) woman status post right GM and left breast reduction 3 years ago at an outside institution. She reportedly had gigantomastia before surgery, although these photographs are unavailable.…”