Prevention and management of post-deep inferior epigastric perforator flap abdominal bulge: A 5-year single-surgeon series

Abstract

Abdominal bulge in the absence of a hernia is a known complication following free abdominal flap breast reconstruction and can be associated with significant aesthetic and functional morbidity. This study aims to review the impact of permanent subrectus mesh placement on the incidence of post-DIEP bulge. All patients over a 5-year period who underwent unilateral or bilateral DIEP breast reconstruction were included in the study. The cohort was divided into a "permanent mesh" (PM) and "no permanent mesh" (NPM) groups. Those in the PM group underwent placement of a permanent Bard™ Soft Polypropylene Mesh, and the NPM group comprised of patients who had a semi-permanent subrectus VyproⓇ mesh or no mesh. The primary outcome of the study was the development of post-DIEP abdominal bulge or hernia. The secondary outcome was the incidence of other donor site complications such as infection. Post-operative follow-up was conducted for a minimum of 6 months. The study included 276 patients, 134 of whom were in the NPM group and 142 in the PM group. Demographics including mean age, median BMI, incidence of pre-operative chemotherapy, radiotherapy, and prior abdominal surgery were comparable between the two groups. The incidence of post-operative abdominal bulge or hernia was lower in the PM group (PM= 0.7% vs. NPM=5.2%, p<0.05). There was no significant difference in the incidence of donor site infection between the two groups (PM=3.5 vs. NPM=2.2%, p=0.53). Our study demonstrates that a low rate of abdominal morbidity can be achieved with the placement of a permanent subrectus mesh.