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

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.