The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Abstract

Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

Management of patients with BRCA mutation from the point of view of a breast surgeon

“…This one-step procedure is shown to be safe, feasible and well accepted [ 133 ]. The combined approach is positive in terms of cost-effectiveness ([ 152 , 153 ]), particularly for patients who had prior radiotherapy. Free flap surgery is an excellent option for autologous breast reconstruction, with low rate of donor site morbidity and low complication rate [ 153 ].…”

Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction

“… 14 As to age at surgery, smoking status, diabetes mellitus, and neoadjuvant chemotherapy numerous studies have concluded that there is no significantly higher risk of seroma formation linked to the factors, which corresponds to our findings. 15 16 17 21 It must be stated, however, that some of these studies did not analyze seroma as a donor site complication separately but rather as part of a group of possible complications (mostly in the form of minor complications). Additionally, the low incidence of smokers ( n = 17) and diabetics ( n = 3) in our study is a limiting factor.…”

Rekonstruktives Vorgehen zum Brustwiederaufbau bei geplanter Bestrahlung

“…50 % der Implantatverluste seien dabei in den ersten 2 Jahren aufgetreten. Im Gegensatz hierzu ist nach einer mikrochirurgischen autologen Rekonstruktion ein Komplettversagen, d. h. ein totaler Lappenverlust von in der Regel lediglich 1-2 % [82] zu verzeichnen und sollte immer in die ausführliche Patientinnenberatung hinsichtlich der Wahl der Rekonstruktionsmethode einfließen. Ein wertvoller praktischer Gesichtspunkt im Rahmen der Diskussion, ob die heterologe oder autologe Vorgehensweise bei der Rekonstruktion zu favorisieren ist, stellt bei initialer Verwendung eines Implantats die Möglichkeit dar, alle anderen Optionen inklusive autologer Rekonstruktion für spätere Rekonstruktionsalternativen weiterhin offen zu haben.…”