Safety of Combined Deep Inferior Epigastric Artery Perforator Flaps and Gynecologic Procedures

Multidisciplinary breast cancer treatment is essential. For some patients, risk-reducing gynecologic procedures are a necessary addition. The deep inferior epigastric artery perforator (DIEP) flap for autologous breast reconstruction shares a common abdominal surgical site with open gynecological procedures, but the impact of concurrent surgery remains to be seen.

A retrospective chart review of all patients undergoing DIEP flap breast reconstruction with and without gynecologic procedures at our institution from 2017 to 2022 was performed.

Patients undergoing combined DIEP flaps and gynecologic procedures were younger (44.6 vs 51.9, P = 0.0066) and more likely to undergo bilateral (88.2% vs 44.3%, P = 0.0004) and prophylactic (35.3% vs 9.7%, P = 0.0013) mastectomies. Concurrent surgery was associated with longer operating time (500 vs 401 minutes, P = 0.0039), greater estimated blood loss (299.1 vs 150.8 cc, P < 0.000001), but unchanged length of stay (2.59 vs 2.81 days, P = 0.51) and opioid usage (115.2 vs 122.2 morphine milligram equivalent, P = 0.80). There were increased rates of hernia and bulge in the combined procedure cohort (17.6% vs. 5.5%, P = 0.0464). Rates of flap loss, infection, and wounds were similar between the 2 cohorts. Total cost increased ($33,700 vs $28,416, P = 0.0231) but cost margin was unchanged.

Combining DIEP flap and gynecologic procedures is safe and well tolerated without differences in flap loss, length of stay, opioid use, or cost margins. However, operative time and postoperative hernia/bulge rates are higher. Plastic surgeons must be vigilant with patient selection and with abdominal wall preservation when considering combining abdominally based autologous breast reconstruction and gynecologic procedures.