Abstract
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.
Keywords
breast reconstruction - DIEP flap - donor-site scar
