title: DIEAP flap for safe definitive autologous breast reconstruction.
abstract: BACKGROUND
  Breast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.
  
  
  METHODS
  1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.
  
  
  RESULTS
  Overall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).
  
  
  CONCLUSIONS
  The DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.
authors.affiliation: Department for Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf, Gräulingerstr. 120, Düsseldorf, DE 40625, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Seidenstuecker
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
authors.forename: Carl
authors.initials: C
authors.lastname: van Waes
authors.affiliation: Department for Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf, Gräulingerstr. 120, Düsseldorf, DE 40625, Germany.
authors.forename: Beatrix I
authors.initials: BI
authors.lastname: Munder
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
authors.forename: Karel E Y
authors.initials: KE
authors.lastname: Claes
authors.affiliation: Department for Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf, Gräulingerstr. 120, Düsseldorf, DE 40625, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Witzel
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roche
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Stillaert
authors.affiliation: Department of Plastic and Reconstructive Surgery, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, United Kingdom. Electronic address: almahajan@yahoo.com.
authors.forename: Ajay L
authors.initials: AL
authors.lastname: Mahajan
authors.affiliation: Department for Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf, Gräulingerstr. 120, Düsseldorf, DE 40625, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Andree
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
authors.forename: Phillip N
authors.initials: PN
authors.lastname: Blondeel
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000601:surgery*; D000328:Adult; D000368:Aged; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Autologous breast reconstruction; Breast reconstruction; DIEAP flap breast reconstruction; Free flap breast reconstruction