Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study

Abstract

Purpose Immediate breast reconstruction (IBR) at the time of mastectomy is gaining popularity, as studies show no negative impact on recurrence or patient survival, but better aesthetic outcome, less psychological distress and lower treatment costs. Using the largest database available in Europe, the presented study compared outcomes and complications of IBR vs. delayed breast reconstruction (DBR). Methods 3926 female patients underwent 4577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups according to the time of reconstruction: an IBR and a DBR group. Surgical complications were accounted for and the groups were then compared. Results Overall, the rate of partial-(1.0 versus 1.2 percent of cases; p = 0.706) and total flap loss (2.3 versus 1.9 percent of cases; p = 0.516) showed no significant difference between the groups. The rate of revision surgery was slightly, but significantly lower in the IBR group (7.7 versus 9.8 percent; p = 0.039). Postoperative mobilization was commenced significantly earlier in the IBR group (mobilization on postoperative day 1: 82.1 versus 68.7 percent; p < 0.001), and concordantly the mean length of hospital stay was significantly shorter (7.3 (SD3.7) versus 8.9 (SD13.0) days; p < 0.001). Conclusion IBR is feasible and cannot be considered a risk factor for complications or flap outcome. Our results support the current trend towards an increasing number of IBR. Especially in times of economic pressure in health care, the importance of a decrease of hospitalization cannot be overemphasized.

A Comparison Between Immediate and Babysitter Deep Inferior Epigastric Perforator Flap Breast Reconstruction in Postoperative Outcomes

“…To our knowledge, only 2 studies have compared complication profiles between immediate and delayed-immediate DIEP flaps for breast reconstruction. 10,11 Similarly to both of these studies, we found no significant differences in major complications including anastomotic failure, partial or complete flap loss, and VTE. 10,11 However, in contrast to these studies, our analysis did not show any difference in the incidence of breast hematomas, which we classify as a major complication given it can compromise the flap and often requires reoperation.…”

“…10 Conversely, a different study conducted in Germany showed that, although there were no significant differences in major complications or donor-site complications, the delayed cohort had a significantly higher rate of breast hematomas. 11 Given these discrepancies in the existing literature, we sought to examine outcomes in our patient population. The primary aim of this study was to compare complication rates between patients who underwent delayed-immediate reconstruction, defined as immediate tissue expander or implant placement at the time of mastectomy followed by exchange for DIEP flap at a later date, with those who had immediate DIEP flap reconstruction at the time of the mastectomy.…”

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

“…Patient data were obtained from the DGPRÄC national online registry for microsurgical breast reconstructions, including data sets from January 2011–July 2018. Parts of this database have been previously investigated by our study group [ 18 , 19 , 20 , 21 , 22 ]. Fritschen et al have described the purpose and design of the registry in detail [ 17 ].…”

Comparison of venous couplers versus hand‐sewn technique in 4577 cases of DIEP‐flap breast reconstructions – A multicenter study

“…The registry has been utilized previously to determine different outcome parameters and risk factors of DIEP flap breast reconstruction (Prantl et al, 2020a(Prantl et al, , 2020b.…”