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Uni-vs. bilateral DIEP flap reconstruction - A multicenter outcome analysis.

N Moellhoff1, L Prantl2, Uv Fritschen3

  • 1Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany.

Surgical Oncology
|May 22, 2021
PubMed
Summary

Bilateral DIEP flap reconstruction is feasible, showing comparable flap loss and thrombosis rates to unilateral procedures. However, unilateral reconstructions had higher hematoma rates at both donor and recipient sites.

Keywords:
AutologousBilateralBreast reconstructionDIEP Flap

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Area of Science:

  • Plastic Surgery
  • Oncology
  • Microsurgery

Background:

  • Bilateral mastectomy rates have risen, increasing demand for bilateral breast reconstruction.
  • Deep Inferior Epigastric Perforator (DIEP) flap reconstruction is a popular autologous option.

Purpose of the Study:

  • To compare complications and outcomes of unilateral (UL) versus bilateral (BL) DIEP free-flap breast reconstructions.
  • To analyze the largest European database for DIEP flap outcomes.

Main Methods:

  • Retrospective analysis of 3926 female breast cancer patients undergoing 4577 DIEP flap reconstructions across 22 European centers.
  • Stratification of free flaps into unilateral (UL) and bilateral (BL) reconstruction groups.
  • Comparison of surgical complications and flap outcomes between UL and BL groups.

Main Results:

  • Mean operative time was longer for BL reconstructions (399.1 min) vs. UL (285.2 min).
  • No significant differences in total flap loss (2.6% BL vs. 1.8% UL) or thrombosis rates.
  • Higher rates of hematoma observed in the UL group at both donor (1.1%) and recipient (3.9%) sites compared to BL (0.1% and 1.7%, respectively).

Conclusions:

  • Bilateral DIEP flap reconstruction is a feasible and safe option when performed in specialized centers.
  • DIEP flap outcomes are comparable between unilateral and bilateral reconstructions, with specific complication profiles differing.