A comparison of postoperative pain between DIEP and extended Latissimus dorsi flaps in breast reconstruction

Background: The senior author (A.P.) has performed 70 consecutive breast reconstructions over 3 years using the free deep inferior epigastric perforator (DIEP) and pedicled extended latissimus dorsi flaps. This study set out to compare these two methods of reconstruction by looking at postoperative morphine requirements and lengths of stay in hospital. Methods: Patient notes were retrospectively reviewed and the total morphine used by patient-controlled analgesia was measured. Results: The mean morphine per kilogram required by patients who had DIEP flaps (0.21 mg/kg; n = 22) was significantly less than the amount required by patients who had extended latissimus dorsi flaps (0.47 mg/kg; n = 48; p < 0.001). An observed trend also revealed that DIEP flap patients remained in hospital for less time compared with extended latissimus dorsi flap patients, although the difference was not significant (p > 0.01). Conclusions: This study shows that DIEP flap patients require less postoperative morphine and therefore might experience less pain than extended latissimus dorsi flap patients. DIEP flap patients may also leave the hospital sooner.