[Breast reconstruction by DIEP free flap: about 100 cases]

Autologous breast reconstruction was stigmatised because the muscular sacrifice of the rectus abdominis muscle. This problem could be avoided by the DIEP flap as much for immediate as delayed reconstruction with the creation of an aesthetic and natural shaped reconstructed breast. This retrospective study about 100 cases performed between January 1997 and June 2002 concern 94 patients, 88 unilateral reconstructions and six bilateral. The reconstruction was delayed in 83%, immediate in 8% or realised after failed attempt to reconstruct the breast with implant in 9%. Risk factors were also present: smokers (66%), one or more abdominal scars (40%), obesity (30%). The recipient vessels were the internal mammary vessels (86%), the circumflex scapular vessels (10%) and the subscapular vessels (4%). We noted four total flap loss, 5% of partial loss and 2% localized liponecrosis. Mean operating time was 6 hours 28 minutes for unilateral reconstruction and 9 hours 30 minutes for bilateral reconstruction. Mean hospital stay was 7,3 days. Two moderated abdominal bulging were noted. The tedious dissection of small vessels of the DIEP flap allowed for a similar rate of complication as the free TRAM flap, by respecting of the integrity of the rectus abdominis muscle, to reduce morbidity of harvest with less postoperative pain, shorter hospital stay and faster recovery.