Population Assessment of Anatomic Eligibility for Robotic-Assisted DIEP Flap

Area of Science:

• Plastic Surgery
• Surgical Innovation
• Breast Reconstruction

Background:

• Traditional deep inferior epigastric perforator (DIEP) flap breast reconstruction can lead to abdominal wall morbidity.
• Robotic-assisted DIEP (R-DIEP) aims to minimize this by reducing fascial incision length.
• Identifying optimal candidates for R-DIEP requires understanding perforator anatomy, specifically diameter and intramuscular course length.

Purpose of the Study:

• To determine the proportion of patients anatomically eligible for robotic-assisted deep inferior epigastric perforator (R-DIEP) breast reconstruction.
• To quantify the prevalence of suitable perforator characteristics for R-DIEP.
• To evaluate eligibility using both conservative and liberal intramuscular course criteria.

Main Methods:

• Retrospective review of 287 patients undergoing magnetic resonance angiography (MRA) perforator mapping before DIEP flap breast reconstruction (2019-2023).
• Analysis of dominant perforator diameter (>2mm) and intramuscular course length (≤2.5cm for conservative, ≤5cm for liberal criteria).
• Calculation of perforator intramuscular course length based on MRA data.

Main Results:

• Out of 574 dominant perforators, 29% had a course ≤2.5cm and 77% had a course ≤5cm.
• 46% of patients met conservative criteria (≤2.5cm course), while 93% met liberal criteria (≤5cm course).
• When considering perforator diameter >2mm, 31% met the conservative criteria and 49% met the liberal criteria.

Conclusions:

• A substantial percentage of patients are anatomically eligible for R-DIEP breast reconstruction.
• Eligibility significantly increases when more liberal intramuscular course criteria (≤5cm) are applied.
• These findings support the broader application of R-DIEP in breast reconstruction.