Complications and risk factors in DIEP flap breast reconstruction: a single center retrospective analysis

<b>Introduction:</b> The Deep Inferior Epigastric Perforator (DIEP) flap is a microsurgical technique for breast reconstruction that is increasingly used after mastectomy for breast cancer. It uses skin and fat from the abdomen to create a natural breast without compromising the abdominal muscles.<b>Aim:</b> The aim of this study was to evaluate complications rate of the DIEP flap in breast reconstruction and investigate theinfluence of risk factors and laboratory parameters on surgical outcomes.<b>Materials and methods:</b> Thirty-two patients met the inclusion criteria for DIEP flap breast reconstruction between 3 June 2020 and 19 September 2023. A total of 38 DIEP flap reconstructions were performed, following standardized surgical and perioperative protocols.<b>Results:</b> Complications were minimal: one case (3%) of total flap loss and five cases (16%) of marginal necrosis. Preoperative haematocrit was associated with marginal necrosis (p = 0.03). Other factors, such as body mass index (BMI), laterality, and oncological therapies, did not significantly affect outcomes. These results are consistent with the current literature and demonstrate the safety and efficacy of DIEP flap reconstruction. Advances such as preoperative imaging have improved surgical outcomes.<b>Conclusions:</b> Despite limitations, our data suggest that DIEP flap reconstruction can be performed safely, regardless of thetime since mastectomy or prior oncological treatment. The weak correlation between elevated haematocrit and marginalnecrosis should be monitored perioperatively. DIEP flap offers good aesthetic results and should be considered for a widerange of mastectomy patients.<b>Significance for the field:</b> This study highlights DIEP flap reconstruction as a safe option and emphasizes the need forcontinued refinement of perioperative care to optimize outcomes.