Bilateral breast reconstruction with a two-stage DIEP flap: A single-center experience

The deep inferior epigastric perforator flap (DIEP) is the gold standard for autologous breast reconstruction (ABR), but its viability can be challenged in resource-reduced environments like Mexico, where bilateral DIEP reconstructions are rare due to their complexity. A two-stage procedure has been introduced to improve flap viability and mitigate surgeon-related factors.

This study is to describe the two-stage technique to improve flap survival in bilateral DIEP flap reconstructions and to report the results in a center with limited hours and resources.

A retrospective case series included women aged≥18years who underwent two-stage bilateral DIEP flap procedures, either immediately or delayed, from January 2021 to July 2024. Key variables assessed included flap success rates, demographics, risk factors, complications, and surgical times.

Twenty breasts were reconstructed in 10 patients. The mean age was 49.5years, 4 were smokers, 3 had prior abdominal surgeries, and 7 had received radiotherapy. The first-stage surgery averaged 145.5minutes, with a 4.3-day interval before the second stage, which lasted 243minutes. The overall flap success was 100%, with one case of partial flap loss, which did not compromise the final outcome. Complications included wound dehiscence (10%) and venous congestion (5%). The average hospital stay was 9.6days.

The two-stage DIEP flap technique is a viable option for high-risk patients, yielding satisfactory outcomes and reducing complications. This method addresses surgeon-related challenges, enhancing overall results. Further research on flap delay in free flaps is recommended for improved practices in difficult settings.