Assessment of breast reconstruction with DIEP flaps

University dissertation from Lund University, Faculty of Medicine

Abstract: Reconstruction with a Deep Inferior Epigastric Perforator (DIEP) flap is considered to be the first choice for autologous breast reconstruction. Skin and fat are transplanted from the lower abdomen to the chest were the blood vessels are reconnected through microsurgery. A total of 309 patients with unilateral DIEP flap and 23 patients with expander prosthesis (EP) reconstructions were included in the present studies aimed at illustrating and optimizing breast reconstruction with the DIEP flap technique. We evaluated blood flow before and after indirect heating, as well as sensitivity to touch, cold and warmth in ten women with reconstructed DIEP flaps. Indirect heating caused a significant increase of blood flow in both DIEP flaps and control breasts, and all patients regained some sensation of touch, cold and warmth. Surgery time and complication rates were studied in 64 patients randomized to preoperative mapping of perforators with computer tomography angiography (CTA) or hand-held Doppler ultrasound (US) prior to DIEP surgery. Surgery time and complication rates were nearly the same in the two groups. We studied 301 charts of patients with DIEP flap reconstructions to elucidate the impact of smoking habits and Body mass index (BMI) on complication rates. We discovered a significantly increased rate of donor site complications in former smokers but differences in BMI did not make a significant difference in complications. Fifty patients were studied to assess early differences in health care consumption and complication rates following delayed breast reconstruction in non-irradiated women with DIEP flap or EP. DIEP reconstruction was a more complex and more health care consuming operation compared to EP surgery, which was often an easier solution from the start. In summary, a DIEP flap reconstruction has its advantages and these might be even more obvious in the long run when aspects of patient satisfaction and quality of life can be observed.