title: Breast reconstruction with deep inferior epigastric perforator flaps.
abstract: BACKGROUND
  Approximately 45,000 women are diagnosed with breast cancer in the UK each year. The success of screening and the introduction of adjuvant therapies have meant that prognosis is improving and an increasing number of patients are seeking reconstruction following mastectomy.  The purpose of this study was to evaluate the deep inferior epigastric perforator (DIEP) flap reconstructions performed in Stoke Mandeville Hospital and, through analysis of complications, detail the evolution of the current care pathway.
  
  
  METHODS
  A retrospective analysis was performed  of all the DIEP flap reconstructions performed by the senior author (MT) between July 2003 and December 2010.
  
  
  RESULTS
  Overall, 159 flaps were performed on 141 patients (including 36 bilateral flaps). The average patient age was 49 years (range: 28-70 years) and 13% of flaps were  risk reducing for BRCA1/2. Twenty-six per cent of patients suffered one or more complication post-operatively, including systemic complications (pulmonary embolism 2%) and flap specific complications (partial flap necrosis 9%, reanastomosis 3%, fat necrosis 9%). Seventy-four per cent had further  elective operations including nipple reconstruction (72%), contralateral breast reduction (36%) and scar revision (21%).
  
  
  CONCLUSIONS
  DIEP flaps are a safe and reliable option for breast reconstructions. This series illustrates the significant leaning curve, with complications, operative  time and ischaemic time reducing through the series and post-operative haemoglobin increasing. The complications experienced in this series of 159 flaps with no total flap loss provide the framework for the evolution of the current care pathway including pre-operative imaging, peri-operative  deep vein thrombosis prophylaxis and analgesia.
authors.affiliation: Buckinghamshire Healthcare NHS Trust, UK, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, HP21 8AL, UK. jonathan.cubitt@hotmail.co.uk
authors.forename: J
authors.initials: J
authors.lastname: Cubitt
authors.forename: Z
authors.initials: Z
authors.lastname: Barber
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.forename: M
authors.initials: M
authors.lastname: Tyler
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D016462:Mammaplasty / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013524:Surgical Flaps