Donor site aesthetics and morbidity after DIEP flap breast reconstruction—A retrospective multicenter study

Abstract

The deep inferior epigastric artery perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and muscle‐sparing design. However, donor site results regarding aesthetic outcome are often less favorable. We therefore aimed to identify crucial factors that might increase the risk for abdominal bulging and an impaired aesthetic appearance. We conducted a multicenter study evaluating all patients receiving autologous breast reconstruction using a DIEP flap between 2013 and 2017. Medical records were analyzed with special attention to flap technique, number of perforators, localization of perforator, and donor site complications. In addition, the aesthetic appearance of the abdominal donor site was evaluated by blinded clinicians at one‐year follow‐up. A total of 242 patients underwent DIEP flap breast reconstruction. Abdominal bulging occurred in 7%. Further subgroup analysis revealed a significant correlation between abdominal bulging and two or more perforators (P = .003), the use of lateral row perforators (P = .009), and a higher BMI (P = .002). Obesity (P = .003) and higher patient's age (P = .003) could be identified as risk factors for an undesirable appearance of the donor site. We recommend the use of a medial‐row single perforator whenever possible in order to optimize donor site morbidity and decrease the risk of abdominal bulging. Proper patient selection and careful donor site closure following a standardized approach should be performed to limit the risk of aesthetically undesirable results.

Techniques and Innovations in Flap Engineering: A Review

“…Autologous tissue flaps are currently the gold standard for these kinds of reconstructions, but carry major disadvantages such as limited donor sites, donor site morbidity, and complex and prolonged operations with their own risks. 1 , 2 …”

“…Autologous tissue flaps are currently the gold standard for these kinds of reconstructions, but carry major disadvantages such as limited donor sites, donor site morbidity, and complex and prolonged operations with their own risks. 1,2 While attempting to overcome these obstacles, researchers in the field of tissue engineering are trying to generate novel tissue flaps requiring small or no donor site sacrifice. At the base of existing technologies is the tissue's potential for regeneration.…”

Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study

“…Studies using patient-reported outcome measures (PROMs) found a higher breast-related QoL and greater satisfaction with breasts following ABR compared to IBR [ [14] , [15] , [16] ]. However, donor site morbidity and aesthetic outcomes are major concerns in ABR, which are relatively little addressed in the existing literature [ [17] , [18] , [19] ]. In addition to satisfaction with breasts, aesthetic outcomes of donor sites may also play an important role in the subjective perception of the body.…”

Erhöhung der Sicherheit in der mikrochirurgischen Brustrekonstruktion – Technik und Technologie

“…2 bis 33 % der Fälle beschrieben [25]. Dabei scheint die Anzahl und Lokalisation (laterale Reihe) der eingeschlossenen Perforatoren sowie das Vorliegen einer Adipositas einen deutlichen Einfluss auf die Inzidenz des abdominellen Bulgings zu haben [26]. Einige Autoren empfehlen daher den Einsatz von (teil-) resorbierbaren Netzen zur Vermeidung dieser Komplikation.…”