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A Novel Method to Estimate the Weight of the DIEP Flap in Breast Reconstruction: DIEP-W, a Simple Calculation Formula Using Paraumbilical Flap Thickness
28 October 2015
04 February 2016
06 April 2016 (online)
Background Preoperative estimation of abdominal flap volume is valuable for breast reconstruction, especially in lean patients. The purpose of this study was to develop a formula to estimate the weight of the deep inferior epigastric artery perforator (DIEP) flap using unidimensional parameters.
Methods We retrospectively collected data on 100 consecutive patients who underwent breast reconstruction using the DIEP flap. Multiple linear regression analysis was used to develop a formula to estimate the weight of the flap. Predictor variables included body mass index, height of the flap, width of the flap, and flap thickness on computed tomography angiographic images at three paraumbilical sites: 5 cm right, left, and inferior from the umbilicus. Then we prospectively tested the accuracy of the developed formula in 38 consecutive patients who underwent breast reconstruction with free DIEP flaps.
Results A calculation formula and a smartphone application, DIEP-W was developed from retrospective analysis (R 2 = 92.7%, p < 0.001). In the prospective study, the average estimated weight was 96.3% of the actual weight, giving the formula a mean absolute percentage error of 7.7% (average differences of 45 g). The flap size in the prospective group was significantly smaller (p < 0.001) and donor-site complications were less (p = 0.002) than those of retrospective group.
Conclusion Surgeons can easily calculate the DIEP weight with varying flap dimensions in a real-time fashion using this formula during preoperative planning and intraoperative design. Estimating the flap weight facilitates economical use of the flap, which can lead to reduced donor-site complications.
- 1 Nahabedian MY, Momen B, Galdino G, Manson PN. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 2002; 110 (2) 466-475 , discussion 476–477
- 2 Eder M, Raith S, Jalali J , et al. Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging. Int J CARS 2014; 9 (4) 541-549
- 3 Minn KW, Hong KY, Lee SW. Preoperative TRAM free flap volume estimation for breast reconstruction in lean patients. Ann Plast Surg 2010; 64 (4) 397-401
- 4 van der Pot WJ, Kreulen M, Melis P, Hage JJ. Specific volume of female subcutaneous abdominal tissue as a reference in autologous breast reconstruction. J Reconstr Microsurg 2010; 26 (3) 185-188
- 5 Kubo T, Miki A, Osaki Y, Onoda M. Simple volume estimation of the latissimus dorsi musculocutaneous flap in Asian breast reconstruction. J Plast Surg Hand Surg 2014; 48 (2) 148-151
- 6 Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer (Auckl) 2011; 5: 43-52
- 7 Tomita K, Yano K, Hata Y, Nishibayashi A, Hosokawa K. DIEP flap breast reconstruction using 3-dimensional surface imaging and a printed mold. Plast Reconstr Surg Glob Open 2015; 3 (3) e316
- 8 Longo B, Farcomeni A, Ferri G, Campanale A, Sorotos M, Santanelli F. The BREAST-V: a unifying predictive formula for volume assessment in small, medium, and large breasts. Plast Reconstr Surg 2013; 132 (1) 1e-7e
- 9 Kroll SS. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000; 106 (3) 576-583
- 10 Lee KT, Lee JE, Nam SJ, Han BK, Mun GH. Is Holm Zone III safe from fat necrosis in medial row perforator-based deep inferior epigastric perforator flaps?. Microsurgery 2015; 35 (4) 272-278
- 11 Xu H, Dong J, Wang T. Bipedicle deep inferior epigastric perforator flap for unilateral breast reconstruction: seven years' experience. Plast Reconstr Surg 2009; 124 (6) 1797-1807
- 12 Baumann DP, Lin HY, Chevray PM. Perforator number predicts fat necrosis in a prospective analysis of breast reconstruction with free TRAM, DIEP, and SIEA flaps. Plast Reconstr Surg 2010; 125 (5) 1335-1341
- 13 Grover R, Nelson JA, Fischer JP, Kovach SJ, Serletti JM, Wu LC. The impact of perforator number on deep inferior epigastric perforator flap breast reconstruction. Arch Plast Surg 2014; 41 (1) 63-70
- 14 Kim H, Lim SY, Pyon JK, Bang SI, Oh KS, Mun GH. Preoperative computed tomographic angiography of both donor and recipient sites for microsurgical breast reconstruction. Plast Reconstr Surg 2012; 130 (1) 11e-20e
- 15 Rosson GD, Shridharani SM, Magarakis M , et al. Three-dimensional computed tomographic angiography to predict weight and volume of deep inferior epigastric artery perforator flap for breast reconstruction. Microsurgery 2011; 31 (7) 510-516
- 16 Sotsuka Y, Fujikawa M, Izumi K. Volume of deep inferior epigastric perforator flap quantified preoperatively by using 64-multidetector-row computed tomography. J Plast Reconstr Aesthet Surg 2012; 65 (11) 1601-1603
- 17 Nanidis TG, Ridha H, Jallali N. The use of computed tomography for the estimation of DIEP flap weights in breast reconstruction: a simple mathematical formula. J Plast Reconstr Aesthet Surg 2014; 67 (10) 1352-1356
- 18 Greenspun D, Vasile J, Levine JL , et al. Anatomic imaging of abdominal perforator flaps without ionizing radiation: seeing is believing with magnetic resonance imaging angiography. J Reconstr Microsurg 2010; 26 (1) 37-44
- 19 Masia J, Kosutic D, Clavero JA, Larranaga J, Vives L, Pons G. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg 2010; 26 (1) 21-28
- 20 Yano K, Hosokawa K, Nakai K, Kubo T, Matsuo Y. Regional differences in ultrasonic assessment of subcutaneous fat thickness in the abdomen: effects on the TRAM flap. Ann Plast Surg 2003; 51 (2) 130-135