Donor-Site Morbidity After DIEAP Flap Breast Reconstruction—A 2-Year Postoperative Computed Tomography Comparison

Abstract

Background:The study was undertaken to provide a more complete picture of donor-site morbidity following the deep inferior epigastric artery perforator (DIEAP) flap harvest in breast reconstruction. Most studies evaluating this subject have been performed using ultrasonography. Computed tomography (CT) might provide valuable information.Methods:In 14 patients who were reconstructed with a DIEAP flap, donor-site morbidity was assessed by comparing routine preoperative CT abdomen with CT abdomen performed 2 years postoperatively. The anteroposterior diameter and transverse diameter (TD) of the rectus muscle were measured bilaterally within 4 standardized zones. Diastasis recti abdominis (DRA) was measured in the same zones. The abdominal wall was assessed for hernias, bulging, and seromas.Results:The operated rectus muscle had a significantly increased anteroposterior diameter in 2 zones and decreased TD in 1 zone compared with preoperative measurements. Comparing the operated and nonoperated rectus muscles, the former had a significantly decreased TD in 1 zone. Supraumbilical DRA was significantly decreased with surgery, whereas infraumbilical DRA was significantly increased. No new hernias or bulging were found. Two patients had seroma formation in the abdominal wall.Conclusions:Symmetry of the 2 hemiabdomens is well preserved after DIEAP flap harvest; however, significant changes to the rectus muscles and DRA were observed. Hernia formation does not seem to be a postoperative complication of importance. The study indicates that DIEAP flaps result in limited donor-site morbidity, which for most patients does not outweigh the benefits of free perforator flap breast reconstruction.

Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics

“…Despite preservation of muscle and fascia, functional changes resulting in a weakened abdominal wall result following even DIEP flap harvest result. [10,16,17] The use of mesh is demonstrated to reduce the risk of abdominal hernia and bulging. [11,[18][19][20][21] An extreme example of abdominal rupture following DIEP flap harvest is discussed by Iwabu et al [22] Authors report the patient required emergent surgery, which consisted of primary fascial repair with mesh overlay placement.…”

Robotic Harvest of the Deep Inferior Epigastric Perforator Flap for Breast Reconstruction: A Case Series

“…The DIEP flap has led to decreased abdominal wall morbidity with decreased pain and increased long-term core strength and function relative to the muscle-sparing transverse rectus abdominus myocutaneous flap; however, many of the potential functional benefits of the DIEP are lost with open dissection of the pedicle. 4,5 The hernia occurrence rate after a DIEP flap ranges from 0 to 7 percent and bulging from 2.3 to 33 percent depending on the study reference, [6][7][8][9][10][11] with average length of follow-up of only 6 to 36 months. 12 These follow-up times are inadequate to capture the complication of bulge; acceptable follow-up times in hernia literature are a minimum of 3 years, suggesting that bulge rates may be significantly underreported.…”

Die robotisch-assistierte Hebung der DIEP-Lappenplastik zur Brustrekonstruktion: Fallbericht, technische Aspekte und Identifikation geeigneter Patientinnen

“…Das Verfahren ist in Bezug auf lappenassoziierte Kom plikationen als sicher zu bewerten und in erfahrenen Händen kommt es selten zu Komplikationen. Jedoch ist eine Herniation in bis zu 7 % oder resultierende Bauchwandschwäche in bis zu 33 % eine relevante Hebedefektmorbidität [2][3][4][5][6]. [11][12][13][14].…”

“…Das Verfahren ist in Bezug auf lappenassoziierte Kom plikationen als sicher zu bewerten und in erfahrenen Händen kommt es selten zu Komplikationen. Jedoch ist eine Herniation in bis zu 7 % oder resultierende Bauchwandschwäche in bis zu 33 % eine relevante Hebedefektmorbidität [2][3][4][5][6]. Diese ist bedingt durch die Schwächung des äußeren Blattes der Rektusscheide, welches wesentlich zur Stabilität der Bauchwand beiträgt sowie eine partielle Denervierung des M. rectus abdominis.…”