Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients

Mani, Maria; Wang, Yichen; Harris, Paul A.; James, Simon

doi:10.1002/micr.22524

Cited by 13 publications

(14 citation statements)

References 33 publications

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“…This fairly high complication rate is comparable to those reported in other large studies of DIEP flap breast reconstruction. [31][32][33][34][35][36] Comparing our data to national datasets reveals comparable rates of postoperative hematoma and suggests similar rates of any immediate postoperative complications. 35,36 Fat necrosis is the most common complication in our cohort, affecting 13.6% of patients with prior abdominal surgery and 11.7% of patients with no prior abdominal surgery.…”

Section: Discussionmentioning

confidence: 85%

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

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Background This study examines the effect of prior abdominal surgery on flap, donor-site, and overall complications in women undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and assesses whether preoperative computed tomography angiography (CTA) affects outcomes. Methods All DIEP flaps performed at our institution between 2004 and 2015 were identified retrospectively. Patients were stratified based on a history of prior abdominal surgery and whether or not they underwent a preoperative CTA. A subgroup analysis was performed to compare operative times and incidence of complications using adjusted odds ratios (ORs). Results Over a 12-year period, 425 patients (640 flaps) had prior abdominal surgery, and 393 patients (547 flaps) had no prior abdominal surgery. Of the patients with previous abdominal surgery, 67 (15.7%) underwent preoperative CTA and 333 (78.4%) did not. Patients with prior abdominal surgery were more likely to have donor-site wound complications (OR: 1.82, 95% confidence interval [CI]: 1.15–2.87, p = 0.01), fat necrosis ≥2cm of the transferred flap (OR: 1.39, 95% CI: 1.0–1.94, p = 0.05), and were more likely to have bilateral DIEP flap reconstruction (OR: 1.61, 95% CI: 1.22–2.12, p < 0.001). Preoperative CTA did not reduce the risk of complications and did not affect operative times. Conclusion DIEP flap reconstruction can be safely performed in women with prior abdominal surgery. However, these patients should be counseled that they are at an increased risk for donor-site wound breakdown and fat necrosis of the reconstructed breast. Preoperative CTA does not reduce complication rate, overall operative time, or time needed to dissect perforators in women with abdominal scars.

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Section: Discussionmentioning

confidence: 85%

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

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“…Data shows that adequate reconstruction of breast volume can be performed with the specimen weight to flap weight ratio close to 1.0 for all groups. Earlier studies describe unilateral DIEP reconstructions to be safe and can provide adequate volume in the slim patient group (Kantak et al, ; Mani, Wang, Harris, & James, ). Specific patient populations and abdominal tissue availability has been studied in unilateral abdominal based reconstructions (Minn, Hong, & Lee, ; van der Pot, Kreulen, Melis, & Hage, ; Yap et al, ).…”

Section: Discussionmentioning

confidence: 99%

Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients

et al. 2017

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“…Therefore, the prospective nature of this study might have contributed to higher complication frequencies. Additionally, the limited number of previous studies [21,27,28] focused on breast reconstruction using the CDC registered only surgical-site complications in the reconstructed breast or the donor site and not all systemic complications [21,27,28]. In fact, studies of breast reconstruction rarely report grade I systemic complications, such as PONV, despite the frequent occurrence of PONV in association with breast surgery [29].…”

Section: Considerations Regarding the Resultsmentioning

confidence: 99%

“…A limited number of previous studies on breast reconstruction has used CDC [21,27,28]. They have focused on surgical-site complications in the reconstructed breast or the donor site and not all systemic complications [21,27,28]. In the previous studies it has been noted that the complication frequencies become higher when a systematic system, such as CDC, is used.…”

Section: Asamentioning

confidence: 99%

Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients

Brorson

Thórarinsson

Kölby

et al. 2020

European Journal of Surgical Oncology

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Background: There is little high-quality scientific evidence identifying the best and safest methods for delayed breast reconstruction, with most previous studies retrospective in nature. The primary aim was to compare early complication rates for two different breast-reconstructive methods in radiated and non-radiated patients, using a validated scale. The secondary aim was to identify predictors for complications. Materials and methods: This study represents a clinical, randomized, prospective trial (ClinicalTrials.Gov identifier: NCT03963427), where the patients were divided into two study arms: non-radiated and radiated. In the non-radiated arm, patients were randomized to a one-stage lateral thoracodorsal flap with an implant or two-stage expander reconstruction. In the radiated arm, patients were randomized to a latissimus dorsi reconstruction combined with an implant or deep inferior epigastric artery perforator (DIEP) reconstruction. All adverse events were classified according to ClavieneDindo and summarization of overall morbidity was performed by calculating the Comprehensive Complication Index score. The study was conducted from 2008 to 2020. Results: The complication frequencies were similar for the two surgical methods within each arm. In the non-radiated arm, risk factors for any complication were any comorbidities, and in the radiated arm, factors were a high body mass index and a contralateral operation. Conclusions: The usage of the Clavien-Dindo scale in reconstructive surgery is feasible, but further validation is needed. In non-radiated patients, the frequencies of short-term complications were similar for lateral thoracodorsal flap and expander reconstruction, whereas in radiated patients, they were similar for DIEP and latissimus dorsi. The complication profile of the methods varied.

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Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients

Cited by 13 publications

References 33 publications

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients

Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients

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