Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions

J Beugels,L Bod,R R W J Van Der Hulst,S M H Tuinder,A Piatkowski,E M Heuts,S S Qiu,S M J Van Kuijk

doi:10.1007/s10549-018-4695-0

Abstract

PurposeAs more breast cancer patients opt for immediate breast reconstruction, the incidence of complications should be evaluated. The aim of this study was to analyze the recipient-site complications and flap re-explorations of immediate compared to delayed deep inferior epigastric artery perforator (DIEP) flap breast reconstructions.MethodsFor this multicenter retrospective cohort study, the medical records of all patients who underwent DIEP flap breast reconstruction in three hospitals in the Netherlands between January 2010 and June 2017 were reviewed. Patient demographics, risk factors, timing of reconstruction, recipient-site complications, and flap re-explorations were recorded.ResultsA total of 910 DIEP flap breast reconstructions (n = 397 immediate and n = 513 delayed reconstructions) in 737 patients were included. There were no significant differences in major complications or flap re-explorations between immediate and delayed reconstructions. The total flap failure rate was 1.5 and 2.5% in the immediate and delayed group, respectively. Significantly more hematomas (OR 2.91; 95% CI 1.59–5.30; p = 0.001) and seromas (OR 3.60; 95% CI 1.14–11.4; p = 0.029) occurred in immediate reconstructions, whereas wound problems were more frequently observed in delayed reconstructions (OR 1.99; 95% CI 1.27–3.11; p = 0.003). Correction for potential confounders still showed significant differences for hematoma and seroma, but no longer for wound problems (p = 0.052).ConclusionsThis study demonstrated similar incidences of major recipient-site complications and flap re-explorations between immediate and delayed DIEP flap breast reconstructions. However, hematoma and seroma occurred significantly more often in immediate reconstructions, while wound problems were more frequently observed in delayed reconstructions.

Highlights

Over the last two decades, the number of women seeking breast reconstruction has increased
post-mastectomy radiation therapy (PMRT) has been associated with increased complications and poorer outcomes in immediate reconstructions, the literature regarding the optimal timing of radiation therapy and breast reconstruction remains controversial [19,20,21,22]
Patients in the delayed group more often had a history of tissue expanders or implants (p < 0.001) and more frequently underwent mastectomy due to breast cancer followed by unilateral deep inferior epigastric artery perforator (DIEP) flap reconstructions (p < 0.001)

Summary

Introduction

Over the last two decades, the number of women seeking breast reconstruction has increased. An important factor that influences the timing of the reconstruction is having an indication for post-mastectomy radiation therapy (PMRT). PMRT has been associated with increased complications and poorer outcomes in immediate reconstructions, the literature regarding the optimal timing of radiation therapy and breast reconstruction remains controversial [19,20,21,22]. As more women opt for immediate breast reconstruction, the incidence of complications following immediate and delayed autologous breast reconstruction should be evaluated. Most studies that evaluated the complication rates compared autologous to implant-based reconstructions and focused on the role of PMRT. The aim of this study was to analyze the recipient-site complications and flap re-explorations of immediate compared to delayed DIEP flap breast reconstructions

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Discussion

Conclusion