Use of Strict Patient Selection Criteria to Achieve Significant Surgical Outcomes from a Low DIEP Flap Breast Reconstruction
10 February 2019
15 April 2019
29 May 2019 (eFirst)
Background The low deep inferior epigastric perforator (DIEP) flap was first introduced in 2016 as it had aesthetic advantages over the conventional DIEP flap. With our experience of over 100 low DIEP flap procedures to date, we have conspicuously lowered complication rates and established more definitive criteria to select proper candidates.
Methods We analyzed 103 patients who underwent breast reconstruction with the low DIEP flap at our hospital between May 2014 and June 2018. Demographics, patient selection criteria, flap specifics, surgical outcomes including postoperative complications, and the location of the abdominal scar and umbilicus were reviewed retrospectively.
Results The mean patient age was 46.7 years, and the average body mass index was 23.7 kg/m2. A low DIEP with an average weight of 377 g was utilized within 6 hours 17 minutes in this cohort. There was no significant difference in the rate of venous congestion or fat necrosis compared with the conventional DIEP flap. The average distance from the pubic hairline to the abdominal scar was 0.6 cm and from the anterior superior iliac spine to the abdominal scar was −0.4 cm. The postoperative location of the umbilicus was 7.0 cm above the pubic hairline.
Conclusion The low DIEP flap is not only a reliable option for a breast reconstruction but is an aesthetically superior approach with a lower abdominal scar and natural umbilicus. Patients may benefit from this technique if prudently selected by computed tomography (CT) angiography. A perforator that is larger than 1 mm in diameter and well enhanced on CT angiography from the division of the external iliac artery to the abdominal skin particularly in the intramuscular course should be selected.
None of the authors has a financial interest to declare in relation to the content of this article.
- 1 Eom JS, Kim DY, Kim EK, Lee TJ. The low DIEP flap: an enhancement to the abdominal donor site. Plast Reconstr Surg 2016; 137 (01) 7e-13e
- 2 Eom JS, Yim JH. The low DIEP flap for breast reconstruction. Plast Reconstr Surg Glob Open 2018; 6 (03) e1365
- 3 Erdmann-Sager J, Wilkins EG, Pusic AL. , et al. Complications and patient-reported outcomes after abdominally based breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. Plast Reconstr Surg 2018; 141 (02) 271-281
- 4 Liu T, Freijs C, Klein HJ. , et al. Patients with abdominal-based free flap breast reconstruction a decade after surgery: a comprehensive long-term follow-up study. J Plast Reconstr Aesthet Surg 2018; 71 (09) 1301-1309
- 5 Niddam J, Bosc R, Lange F. , et al. DIEP flap for breast reconstruction: retrospective evaluation of patient satisfaction on abdominal results. J Plast Reconstr Aesthet Surg 2014; 67 (06) 789-796
- 6 Edsander-Nord A, Brandberg Y, Wickman M. Quality of life, patients' satisfaction, and aesthetic outcome after pedicled or free TRAM flap breast surgery. Plast Reconstr Surg 2001; 107 (05) 1142-1153 , discussion 1154–1155
- 7 Stalder MW, Accardo K, Allen RJ, Sadeghi A. Aesthetic refinement of the abdominal donor site after autologous breast reconstruction. Plast Reconstr Surg 2015; 136 (03) 455-461
- 8 Joseph WJ, Sinno S, Brownstone ND, Mirrer J, Thanik VD. Creating the perfect umbilicus: a systematic review of recent literature. Aesthetic Plast Surg 2016; 40 (03) 372-379
- 9 van Veldhuisen CL, Kamali P, Wu W. , et al. Prospective, double-blind evaluation of umbilicoplasty techniques using conventional and crowdsourcing methods. Plast Reconstr Surg 2017; 140 (06) 1151-1162