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

Abstract

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

Deep Inferior Epigastric Perforator Flap for Immediate Breast Reconstruction following Mastectomy in Breast Cancer Patients: An Initial Experience in Vietnam

“…The mean hospital stays in our study were longer than in other centers (12.6 vs. 8.45 days) [ 18 ]. It can be distributed to the difference in structure of outpatient care between the healthcare systems.…”

“…However, we need further prospective or randomized control trials to support its use to reduce the risk of venous congestion. The rate of reoperation has been decreasing, owing to experience gaining over time, especially that rate fell from 15% in initial reports to 2.6% in recent reports in high-volume centers where more than 40 DIEP flaps were performed per year [17][18][19]. Along with an accumulation of cases, proper education and training would help surgeons and centers with less experience perform breast reconstruction safely and reduce the learning curve period.…”

Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study

“…Yet, a tendency toward a higher rate of revision surgery was seen in those patients that died in due course, with 18% of flaps requiring surgical revision. In addition, flap loss was higher in this patient group, reaching 12%, which is markedly higher compared to flap loss rates reported in the literature, as well as the flap loss rates in patients alive at the end of the study period (3%) [ 27 , 28 , 29 ]. It is worth noting that patients who died in the short- or mid-term follow-up after surgery had a significantly higher ASA status and suffered significantly more frequently from cardiovascular and metabolic diseases.…”

The Use of Closed Incision Negative Pressure Therapy on the Medial Thigh Donor Site in Transverse Musculocutaneous Gracilis Flap Breast Reconstruction

“…Free flap breast reconstruction is considered the gold standard for post-mastectomy breast reconstruction, with success rates ofabove 98% [ 1 , 2 ]. Various free flaps enable plastic surgeons to individualize microsurgical breast reconstruction to patients’ preconditions and demands [ 3 ].…”