10-Year Experience of Hybrid DIEP with Implant Breast Reconstruction: Univariate Analyses of Risk Factors Associated...

The combination of deep inferior epigastric artery perforator (DIEP) free flap and implant has been reported as a safe option for breast reconstruction in patients with insufficient abdominal donor tissue. We present a single-surgeon 10-year experience with hybrid reconstruction.

We performed a retrospective review of patients who underwent hybrid breast reconstruction with DIEP and implant by a single surgeon at a single institution between 2014-2024. Patient characteristics and operative factors were analyzed for association with flap failure.

91 patients (153 breasts) were included. Success rate following initial (simultaneous or delayed) implantation and after implant exchange were 98% and 96.1%, respectively. Univariate analyses showed significantly larger mean final implant size in the failed DIEP group (362.50±228.05 mL) compared to the successful reconstruction group (219.20±101.24 mL), with OR of 1.42 (95% CI: 1.149-1.76, p-value = 0.002) per 50 mL increase of the implant size.

Hybrid DIEP with implant reconstruction is a safe procedure. Placement of a greater volume implant is associated with flap failure. Implant exchange for upsize also possesses a risk of flap failure.