title: Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: an experience with 280 flaps.
abstract: Bilateral prophylactic mastectomy can reduce the incidence of breast cancer by 87 to 93% in high-risk individuals and is an appealing option for many patients if reconstruction can be provided with acceptable morbidity and outstanding esthetic results. Autogenous breast reconstruction techniques have evolved over the last 20 years to meet this goal. Familiarity with the deep inferior epigastric perforator (DIEP) flap led us to carry out simultaneous bilateral breast reconstruction with acceptable morbidity and superior esthetic outcome in 3 patient groups: (1) after bilateral prophylactic mastectomy, (2) after therapeutic and contralateral prophylactic mastectomy, and (3) after explantation of bilateral implant failures. A retrospective review of our experience with 280 flaps in 140 patients was performed. Average operating times, including time for implant removal or mastectomy and reconstruction, was 7.3 hours. Average hospitalization was 3.9 days. Significant perioperative complications occurred in 9 patients (6.4%); all returned to the operating room. This included 7 microvascular complications, 1 hematoma, 1 seroma, and 1 DVT. Less significant complications were divided into early and late. The early complications included 1.8% partial flap necrosis, 4.2% abdominal apron necrosis greater than 5 cm2, 2.9% seromas that required intervention, and 5.7% partial breast flap dehiscence. Late complications included 12.5% fat necrosis of any size and 2.1% hernia formation. Smoking, obesity, age, history of chest wall radiation, and flap size were evaluated as risk factors for increased morbidity.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Aldo Benjamin
authors.initials: AB
authors.lastname: Guerra
authors.forename: Stephen Eric
authors.initials: SE
authors.lastname: Metzinger
authors.forename: Rafi Sirop
authors.initials: RS
authors.lastname: Bidros
authors.forename: Richard Patrick
authors.initials: RP
authors.lastname: Rizzuto
authors.forename: Paul Singh
authors.initials: PS
authors.lastname: Gill
authors.forename: Anthony Hung
authors.initials: AH
authors.lastname: Nguyen
authors.forename: Charles Louis
authors.initials: CL
authors.lastname: Dupin
authors.forename: Robert Johnson
authors.initials: RJ
authors.lastname: Allen
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome