Donor site morbidity in DIEP free flap breast reconstructions: A comparison of unilateral, bilateral, and bipedicled surgical procedure types

Tomouk, Taj; Mohan, Anita T.; Azizi, Alex; Conci, Elena; Brickley, Elizabeth B; Malata, Charles M.

doi:10.1016/j.bjps.2017.05.044

Cited by 38 publications

(35 citation statements)

References 22 publications

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“…Indeed, the incidence of fascial abdominal bulge and hernias has declined significantly since it has replaced the use of the TRAM flaps 7 . However, the incidence of abdominal bulging is still high and varies from 2.3% to 33% 8‐10 . Our incidence of 7% is well in line with these studies.…”

Section: Discussionsupporting

confidence: 75%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 75%

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

et al. 2020

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“…Figure 1 shows the inclusion process used in study selection, which identified 20 studies for final analysis. Table 1 presented the features [ 23 – 42 ] of included studies. All these studies were case-control in nature, including 3 prospective studies and 17 retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

A comparative study for the rate of adverse outcomes in unilateral and bilateral abdominal flap breast reconstruction

Cao

Pang

et al. 2020

Medicine

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Background: Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation. Methods: To address this research need, PubMed, Ovid, Medline, EMBASE, and Scopus databases were searched through systematically from January 1, 1990, to January 1, 2019 to retrieve the relevant studies on the risk of postoperative complications after unilateral vs bilateral abdominal flap breast reconstruction. According to the pre-designed inclusion criteria, available data were extracted from the relevant studies, and then analyzed comparatively in order to identify the relative risk (RR) and 95% confidence intervals (CI) applying either a random or a fixed effects model. Results: Eventually, 20 studies involving 8122 female subjects met the inclusion criteria. It was found that unilateral reconstruction involved a significantly higher risk of flap loss (RR: 1.56, 95% CI: 1.21–2.00; P < .05) and fat necrosis (RR: 1.60, 95% CI: 1.23–2.09; P < .05) compared to bilateral reconstruction, while bilateral reconstruction involved a greater risk of abdominal hernia/bulge (RR: 1.67, 95% CI: 1.25–2.24; P < .05). The risk was found to be higher following bilateral free transverse rectus abdominis myocutaneous (fTRAM) flaps in comparison with deep inferior epigastric perforator (DIEP) flaps (RR: 2.62, 95% CI: 1.33–5.15; P < .05). Conclusion: The risk of postoperative flap complications in unilateral breast reconstruction is significantly higher than that in bilateral reconstruction. Contrarily, the abdominal complications were significantly higher in the bilateral group vs the unilateral group. Meanwhile, the risk of abdominal hernia/bulge complication after bilateral breast reconstruction was significantly higher with fTRAM vs DIEP. Therefore, DIEP flaps are recommended in priority for bilateral breast reconstruction, unless specifically contraindicated.

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“…The majority of previous studies compared uni- and bilateral breast reconstructions using DIEP flaps [ 15 , 16 ] or evaluated a single flap type for breast reconstruction, such as superior gluteal artery perforator (SGAP) flaps [ 17 , 18 ] or TMG flaps [ 6 ]. A cohort study comparing two large patient cohorts that underwent bilateral simultaneous reconstructions with either double DIEP or double TMG flaps has not been conducted so far.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

Weitgasser

Schwaiger

Medved

et al. 2020

JCM

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Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.

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Donor site morbidity in DIEP free flap breast reconstructions: A comparison of unilateral, bilateral, and bipedicled surgical procedure types

Cited by 38 publications

References 22 publications

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

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

A comparative study for the rate of adverse outcomes in unilateral and bilateral abdominal flap breast reconstruction

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

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