The pleasing end result after DIEP flap breast reconstruction: a review of additional operations

Background: Breast reconstruction with deep inferior epigastric perforator (DIEP) flaps is typically a three-stage procedure, but additional operations may be required to deal with complications or to improve the aesthetic result. The purpose of this study was to evaluate the total number of operations needed after DIEP flap breast reconstruction to achieve a satisfactory end result for the patient. Patients and methods: From December 2002 to October 2006, 99 DIEP flap breast reconstructions obtained an end result in 72 patients. Data were collected in a structured database. Additional operations and complications were evaluated for the entire group. A study-specific questionnaire was used to evaluate patient satisfaction. Results: The mean number of additional operations was 1.4 per patient. Patients with complications required more operations than patients without complications. Women who chose nipple reconstruction were younger than women who did not and were more likely to have had a primary or secondary than a tertiary reconstruction. The number of additional aesthetic operations was neither related to the occurrence of complications during the initial reconstruction, nor to patient satisfaction. Overall, patients were very satisfied with the end result. Conclusions: Completion of DIEP flap breast reconstruction involved the initial reconstruction and an average of 1.4 additional operations. Patients were generally very satisfied with the end result. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.