The deep inferior epigastric perforator (DIEP) flap was developed as a refinement of the free transverse rectus abdominis myocutaneous flap. It has been reported that no more than 70% of the flap can be used for breast reconstruction due to venous congestion in the distal zone of the flap. Asian women are usually relatively thin. Often, it is necessary to use almost the entire abdominal flap in order to achieve enough volume and symmetric shape for breast reconstruction. The objective of this study was to investigate the relability of the DIEP when zone IV is included.
From March 2000 to June 2002, 74 DIEP flaps were performed in 73 patients for breast reconstruction at Chang Gung Memorial Hospital. Twenty-five breast reconstructions were immediate and 49 were delayed. The average size of the flap was 30.1 × 12.0 cm. The patient mean age was 44.2 years (range: 27–65 years), the mean body weight was 56.6 kg (range: 40–80 kg).
Total flap failure was not encountered. The mean number of perforators was 2.2. Average weight of the harvested flap was 595 g, and 85.6% (mean: 509 g) of the flap was used for shaping the new breast mound. Only one flap was revised for venous congestion (1.4%) and was successfully salvaged. Partial flap loss occurred in two patients (2.7%). One of them had a history of previous radiotherapy and abdominal scar. Fat necrosis was detected in 13.5% (n = 10) of the cases by either regular physical examination or mammography. The size of the fat necrosis ranged from 2 × 2 cm to 4 × 5 cm. Following excision of the fat necrosis, none of the patients needed additional tissue for restoration of the shape and volume.
The numbers of perforators and the percentage of the flap weight used/total flap weight were not related to complications. Rather, radiation and previous abdominal scar seem to be detrimental for flap survival and flap necrosis. The free DIEP flap and inclusions of zone IV are a reliable and valuable method of breast reconstruction and provide superior aesthetic outcomes.
