Elsevier

The Breast

Volume 26, April 2016, Pages 59-66
The Breast

Original article
DIEAP flap for safe definitive autologous breast reconstruction

https://doi.org/10.1016/j.breast.2015.12.005Get rights and content

Highlights

  • Large series with low complications reiterates its safety in breast reconstructions.

  • These procedures can be safely carried out in a mean operating time of five hours.

  • No significant complications with older age, high BMI, chemotherapy or radiotherapy.

  • Smoking is not contraindicated in microvascular surgery, but affects wound healing.

Abstract

Background

Breast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.

Methods

1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.

Results

Overall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).

Conclusion

The DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.

Section snippets

Background

“An estimated 226,870 new cases of invasive breast cancer are expected to occur amongst women in the US during 2012. In addition, 63,300 new cases of in situ breast cancer are expected (www.cancer.org/statistics)”. Breast cancer is the commonest form of cancer in women resulting in ablation of the breast in about 30% of these patients. Also, more women are being diagnosed with BRCA (Breast Cancer) 1–3 genetic mutation associated with increased risk breast cancer. Many of these patients opt to

Patients and methods

The DIEAP flap procedure involves harvest of excess skin and subcutaneous fat from the lower abdomen that is discarded in a conventional abdominoplasty or “tummy tuck” procedure. This flap is perfused by perforator vessels that arise from the deep inferior epigastric vessels. While harvesting the flap, the blood vessels are carefully dissected along their course through the muscle, preserving the muscle and its nerves (Fig. 1). There is no need to harvest the muscle as is done with the

Results

Patients' age ranged from 22 to 77 years (Mean: 50 years). Adjuvant therapy was administered in the form of radiotherapy in 486 patients and chemotherapy in 440 patients (Table 1). Adjuvant radiotherapy was administered following the mastectomy in 468 patients. The breast reconstruction in these patients was carried out at least 6 month after the end of the radiotherapy. Adjuvant radiotherapy was administered after the microsurgical breast reconstruction with the DIEAP flap in 18 patients from

Discussion

Being affected by cancer has significant psychological impact on the well being of women [13], [14]. Fortunately, we can at least help address the physical impact of this major life-changing event and help restore the feminine form by reconstructing the breast. Breast reconstruction is achieved in various ways, either with a breast implant, with a latissimus dorsi muscle flap with or without an underlying implant or with autologous tissue from the abdomen, gluteal area or inner thigh. We would

Conclusions

In conclusion, the DIEAP flap is an excellent option for breast reconstruction resulting in an aesthetically pleasing restoration of the feminine form but with a low level of donor site morbidity and complications. This is the ideal form of breast reconstruction and surgeons in specialist breast reconstruction centres should promote experience in this technique.

Funding source

None.

Ethical approval

Not required as not an experimental study and privacy rights of human subjects has been observed.

Conflict of interest statement

None.

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