Time-dependent factors in DIEP flap breast reconstruction

Area of Science:

• Microsurgery
• Plastic Surgery
• Oncology

Background:

• Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is a complex procedure.
• Operative time (OT) in DIEP flap surgery can impact outcomes and patient safety.
• Identifying predictors of operative time is crucial for optimizing surgical efficiency.

Purpose of the Study:

• To investigate patient characteristics and surgical factors associated with operative time in DIEP flap breast reconstruction.
• To identify key predictors that influence the duration of DIEP flap surgery.

Main Methods:

• Retrospective analysis of 336 immediate and 68 delayed unilateral DIEP flap breast reconstructions (2004-2016).
• Collected data included patient demographics (age, BMI, weight), mastectomy type, flap characteristics (weight, perforator number), recipient vessel selection, and surgical team experience.
• Statistical analysis, including univariate and multivariate regression, was used to identify predictors of operative time.

Main Results:

• Mean operative time was 289 minutes. Increased BMI, patient weight, flap weight, perforator number, and use of internal mammary vessels were associated with longer operative times.
• Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) showed varied impacts on operative time.
• Use of circumflex scapular vessels as recipients, a dedicated anesthesiologist, and the surgical learning curve (LC) were associated with reduced operative time.

Conclusions:

• Factors such as increased flap weight, perforator number, and venous drainage significantly prolong operative time in DIEP flap breast reconstruction.
• The learning curve and the presence of a dedicated anesthesiologist are key factors in optimizing surgical efficiency.
• A systematic approach, including mastering the learning curve, can enhance the efficiency of DIEP flap surgery.