The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Beatrix Munder; Christoph Andree; Christian Witzel; Sonia Fertsch; Peter Stambera; Tino Schulz; Olaf Fleischer; Mazen Hagouan; Lukas Grüter; Birgit Aufmesser; Katinka Staemmler; Julia Kornetka; Mohammed Aldeeri; Katrin Seidenstücker; Alina Abu-Ghazaleh; Andreas Wolter

doi:10.1055/a-1116-2102

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(06): 628-638
DOI: 10.1055/a-1116-2102

GebFra Science

Original Article/Originalarbeit

The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

Article in several languages: English | deutsch

Beatrix Munder

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Christoph Andree

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Christian Witzel

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Sonia Fertsch

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Peter Stambera

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Tino Schulz

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Olaf Fleischer

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Mazen Hagouan

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Lukas Grüter

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Birgit Aufmesser

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Katinka Staemmler

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Julia Kornetka

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Mohammed Aldeeri

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Katrin Seidenstücker

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Alina Abu-Ghazaleh

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

,

Andreas Wolter

¹Klinik für Plastische und Ästhetische Chirurgie, Sana Kliniken Düsseldorf GmbH, Düsseldorf, Germany

²Universität Witten-Herdecke, Fakultät für Gesundheit, Witten, Germany

› Author Affiliations

Abstract

Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications.

Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months.

Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates.

Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

Key words

breast - breast cancer - breast reconstruction - DIEP flap - autologous breast reconstruction - BRCA

Full Text

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