Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: An experience with 280 flaps

• Published in: Annals of plastic surgery Vol. 52; no. 3; pp. 246 - 252
• Main Authors: GUERRA, Aldo Benjamin, METZINGER, Stephen Eric, BIDROS, Raft Sirop, RIZZUTO, Richard Patrick, GILL, Paul Singh, HUNG NGUYEN, Anthony, DUPIN, Charles Louis, ALLEN, Robert Johnson
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-03-2004
• Subjects: Abdominal Wall - surgery; Adult; Aged; Biological and medical sciences; Breast Neoplasms - prevention & control; Breast Neoplasms - surgery; Female; Humans; Length of Stay; Mammaplasty - methods; Mastectomy; Medical sciences; Middle Aged; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps - blood supply; Time Factors; Tissue and Organ Harvesting - methods; Treatment Outcome; Human; Plasty; Experience; Treatment; Surgery; Free flap; Breast; Bilateral; Anatomical reconstruction; Mammary gland; Rectus abdominis muscle
• ISSN: 0148-7043; 1536-3708
• DOI: 10.1097/01.sap.0000110529.37143.96

Bilateral prophylactic mastectomy can reduce the incidence of breast cancer by 87 to 93% in high-risk individuals and is an appealing option for many patients if reconstruction can be provided with acceptable morbidity and outstanding esthetic results. Autogenous breast reconstruction techniques have evolved over the last 20 years to meet this goal. Familiarity with the deep inferior epigastric perforator (DIEP) flap led us to carry out simultaneous bilateral breast reconstruction with acceptable morbidity and superior esthetic outcome in 3 patient groups: (1) after bilateral prophylactic mastectomy, (2) after therapeutic and contralateral prophylactic mastectomy, and (3) after explantation of bilateral implant failures. A retrospective review of our experience with 280 flaps in 140 patients was performed. Average operating times, including time for implant removal or mastectomy and reconstruction, was 7.3 hours. Average hospitalization was 3.9 days. Significant perioperative complications occurred in 9 patients (6.4%); all returned to the operating room. This included 7 microvascular complications, 1 hematoma, 1 seroma, and 1 DVT. Less significant complications were divided into early and late. The early complications included 1.8% partial flap necrosis, 4.2% abdominal apron necrosis greater than 5 cm2, 2.9% seromas that required intervention, and 5.7% partial breast flap dehiscence. Late complications included 12.5% fat necrosis of any size and 2.1% hernia formation. Smoking, obesity, age, history of chest wall radiation, and flap size were evaluated as risk factors for increased morbidity.