Deep inferior epigastric perforator flap for breast reconstruction:experience with 43 flaps

Background In the past decade,there has been increasing breast reconstructions after mastectomy.The idealmaterial for reconstruction of a breast is fat and skin.The transverse rectus abdominis myocutaneous (TRAM) flap hasbeen the gold standard for breast reconstruction until recently.Abdominal wall function is a major concern for plasticsurgeons in breast reconstruction with TRAM flaps.The deep inferior epigastric perforator (DIEP) free flap spares thewhole rectus abdominis muscle,includes skin and fat only,and therefore preserves adequate abdominal wallcompetence.The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005,a total of 43 breast reconstructions were performed on 40 patients byour surgeons using DIEP flap (3 patients had bilateral procedures),14 of them were immediate surgeries and 26 weredelayed.Abdominal function,satisfaction with the donor site and reconstructed breast,and the sensation recovery wasassessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range,28—50).The size of the flaps was 11 cm×26 cm inaverage (height 10—12 cm,width 15—33 cm).The mean length of the vascular pedicles was 9.3 cm (range,7—12).Thepatients were followed up for a mean of 16 months (range,6—30 months).During the follow-up,2 (5%) patients had totalflap loss,2 (5%) had partial necrosis,4 (9%) had wound edge necrosis in the abdomen,and 1 had axillary seroma.Noneof the patients had hernia,and all of them were able to resume their daily activities after the operation.Patient satisfactionwith the reconstructed breast rated high,95% of the patients achieved spontaneous return of sensation in thereconstructed breast,but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectusmuscle.It can reduce donor-site morbidity and provide an aesthetic refinement in breast reconstruction.Chin Med J 2007;120 (5):380-384