Abstract
Background Understanding of donor-site morbidity and satisfaction after breast reconstruction
is limited. There are few previous studies comparing satisfaction with different donor
sites in breast reconstruction. This study aimed to examine the long-term patient-reported
satisfaction with the donor site of latissimus dorsi (LD) flaps in comparison to the
deep inferior epigastric artery perforator (DIEP) flaps. Further, a systematic review
of previously published studies was conducted.
Methods In this retrospective cross-sectional study, all women who underwent breast reconstructions
with either LD or DIEP flap following mastectomy and radiotherapy between 2007 and
2017 were included; patient-reported satisfaction was assessed using the BREAST-Q
reconstruction module. For the systematic review, studies examining patient-reported
abdominal satisfaction and well-being, and meeting the PICO (Population, Intervention,
Comparison, and Outcome) criteria were included.
Results Eligible and responding participants were divided into the LD (n = 135 patients) and DIEP (n = 118 patients) flap groups. Impairment due to muscular weakness of the donor site
was more common in the LD group than that of the DIEP group. Bulging was common in
the DIEP group and increased over time. Regarding the esthetic appearance of the donor
site, the patients in the DIEP group were less satisfied than the LD group. The systematic
review showed that most of the patients were dissatisfied with their abdomen after
the operation.
Conclusion Patients who have undergone DIEP flap for breast reconstruction are less satisfied
with the donor-site esthetics than those who have undergone LD flap. Patient-reported
abdominal bulging was common in the DIEP group and the number seemed to increase over
time. Most patients were not satisfied with their abdominal scarring postoperatively,
as per the systematic review. These results may indicate a need for more nuanced preoperative
patient information, as well as improvements in the surgical management of the donor
site, for DIEP flap reconstructions.
Keywords
latissimus dorsi flap - deep inferior epigastric artery perforator flap - breast reconstruction
- patient-reported outcome - patient satisfaction - long-term
