Breast reconstruction with a DIEP flap for breast cancer: a current trend or a necessary component

Background. Breast reconstruction for breast cancer (BC) is often associated with the development of complications, which can even lead to unsuccessful consequences in the form of loss of an implant or flap. Despite the rapid development of reconstructive surgery for breast cancer, the percentage of complications continues to remain at a high level and can reach 50%. Undoubtedly, complications during reconstruction with implants and flaps are different and have their own specifics. Sometimes we can successfully manage or prevent these complications by choosing the best reconstruction option for that particular patient. Breast reconstruction using a DIEP flap in patients with risk factors minimizes the rate of complications that occur with implant reconstruction, thereby leading to a good aesthetic result.

Purpose of the study: to evaluate the effectiveness and aesthetic acceptability of the DIEP flap in patients with a history of complications after breast reconstruction with implants/expanders and high-risk factors for complications.

Materials and methods. The study performed 20 breast reconstructions using the DIEP flap in patients with risk factors who had previously experienced complications and had failed implant reconstruction.

Results. The total complication rate was 35%. The dominant complication was long-term seroma in the donor area — 3 cases (15%), all of them had obesity of 1.2 degrees. Loss of the flap occurred in 1 (5%) case with a complicated medical history (grade 3 obesity, radiation therapy). Partial necrosis was detected in 1 (5%) of the subjects. Early postoperative hematoma was detected in 1 (5%) case, which required emergency surgical intervention, without loss or partial necrosis of the flap. Postoperative ventral hernia formed in 1 (5%) woman after previous abdominal surgery. It was also noted that patients with a BMI of 30.0 to 35 kg/m2 and 35 kg/m2 or higher were at significantly greater risk of complications compared to patients with a normal BMI (from 18.5 to 25 kg/m2) p-value 0.05. A history of radiation therapy increased the risk of complications. The difference is statistically significant p-value 0.02. There was no effect of chemotherapy on the number of complications encountered. The Breast Q questionnaire showed a good aesthetic result of 72 points.

Conclusions. The use of the DIEP-flap in patients with a history of complications after breast reconstruction with implants/expanders and high-risk factors for complications is an effective and safe method of breast reconstruction with a good cosmetic result.

1. Kaprin A.D., Staritsky V.V., Shakhzadova A.O. Malignant neoplasms in Russia in 2020 (morbidity and mortality). Moscow: Publishing house MNIOI im. P. A. Herzen — branch of the Federal State Budgetary Institution «National Medical Research Center» of the Ministry of Health of Russia, 2021. 252 p.: ill. (In Russ.).

2. Levchuk A.L., Khodyrev S.A., Shabaev R.M. Current state of reconstructive surgery of the mammary glands. Bulletin of events of the Medical and Surgical Center named after N. I. Pirogov, 2021, No. 2 (In Russ.). URL: https://cyberleninka.ru/article/n/sovremennoe-sostoyanie-rekonstruktivno-vosstanovitelnoy-hirurgii-molochnyh-zhelez.

3. Cordeiro P.G., McCarthy C.M. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: Part I. A prospective analysis of early complications // Plast. Reconstruct. Surg. 2006. Vol. 118. Р. 825–831.

4. Wilkins E.G., Hamill J.B., Kim H.M., Kim J.Y., Greco R.J., Qi J., Pusic A.L. Complications in Postmastectomy Breast Reconstruction: One-year Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study // Ann. Surg. 2018. Vol. 67, No. 1. Р. 164–170. doi: 10.1097/SLA.0000000000002033. PMID: 27906762; PMCID: PMC5904787.

5. Fertsch S., Munder B., Andree C., Witzel C., Stambera P., Schulz T., Hagouan M., Gruter L., Aufmesser B., Staemmler K., Kornetka J., Aldeeri M., Seidenstucker K., Abu-Ghazaleh A., Wolter A. Risk Factor Analysis for Flap and Donor Site Related Complications in 1274 DIEP Flaps — Retrospective Single Center Study // Chirurgia (Bucur). 2021. Mar-Apr; Vol. 116 (2 Suppl.). Р. 5–15. PMID: 33963690.

6. Song D., Slater K., Papsdorf M. et al. Autologous breast reconstruction in women older than 65 years versus women younger than 65 years // Ann. Plast. Surg. 2015. Vol. 76. Р. 155–163.

7. McCarthy C.M., Mehrara B.J., Riedel E. et al. Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk // Plast. Reconstruct Surg. 2008. Vol. 121. Р. 1886–1892.

8. Fisher J.P., Nelson J.A., Kovach S.J. et al. Impact of obesity on outcomes in breast reconstruction: analysis of 15937 patients from the ACS-NSQIP datasets // J. Am. Coll Surg. 2013. Vol. 217. Р. 658–664.

9. Fischer J.P. et al. Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps // Plastic and reconstructive surgery. 2013. Vol. 131, No. 2. Р. 195–203.

10. Barry M., Kell M.R. Radiotherapy and breast reconstruction: a meta-analysis // Breast cancer research and treatment. 2011. Vol. 127. Р. 15–22.