Secondary solution for breast reconstruction following total DIEP flap loss: A single-center experience after 3270 DIEP flaps

Abstract

BackgroundTotal DIEP flap failure is a significant concern in autologous breast reconstruction. Literature on secondary reconstruction options following total flap failure is limited. This study outlines the outcomes of patients who underwent reconstruction post-DIEP flap failure at our institution. MethodsWe conducted a retrospective analysis of patients receiving autologous breast reconstruction between 2004-2021. We aimed to identify causes of total DIEP flap failure, outcomes of revision surgery and outcomes of secondary breast reconstruction procedures. ResultsFrom 2004 to 2021, 3,456 free flaps for breast reconstruction were performed, with 3,270 being DIEP flaps for 2,756 patients. DIEP flap failure was observed in 40 cases (1.22%). Bilateral reconstructions had a higher failure rate (2.31%) than unilateral (0.72%). The primary cause was intraoperative complications during flap harvest (18 cases), followed by insufficient arterial perfusion (seven cases). Other causes included postoperative hematoma (seven cases), venous congestion (six cases), and late-onset fat necrosis (two cases). Post-failure, five patients received a second free flap with three cases of repeated flap failure. Twenty patients received IBR with two cases of reconstruction failure, while seven patients received a pedicled Latissimus Dorsi (LD) flap reconstructions with no cases of reconstruction failure. Eight patients declined further reconstruction. ConclusionA second free flap post-DIEP failure was associated with a high risk of reconstruction failure, suggesting the need for careful patient selection. Implant-based and pedicled LD flap seem to be reliable secondary reconstruction options.