Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany-A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions.

Paul I Heidekrueger,Jörn A Lohmeyer,Mario Marx,Raymund E Horch,Christian J Gabka,Uwe Von Fritschen,Steffen Handstein,Matthias Geenen,Nicholas Moellhoff,Christoph Heitmann,Lukas Prantl,Hisham Fansa

doi:10.3390/jcm10051016

Abstract

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

Highlights

Since its first description in 1979 [1], autologous breast reconstruction has evolved as a safe and viable option
The investigated study sample consisted of 3926 female patients, with a mean age of 51.30 (SD 31.61) years and a mean body mass index (BMI) of 26.28 (SD 4.44) kg/m2, who received 4577 free deep inferior epigastric perforator (DIEP)
Immediate breast reconstructions were performed in 24.8% of cases

Summary

Introduction

Since its first description in 1979 [1], autologous breast reconstruction has evolved as a safe and viable option. More than that, it is regarded as the international gold-standard in reconstructive breast surgery [2,3]. Breast reconstruction is performed either by plastic surgeons or gynecologists. Both specialties often differ significantly in regard to the reconstructive approach preferred, and no clear international or interdisciplinary guidelines exist to support the decision-making process. Rates of autologous reconstruction have continued at a stable, rather than increasing level, for many years [14,15,16]

Objectives

Methods

Results

Discussion

Conclusion