A clinical review of 9 years of free perforator flap breast reconstructions: an analysis of 675 flaps and the influence of new techniques on clinical practice

J Reconstr Microsurg. 2011 Feb;27(2):91-8. doi: 10.1055/s-0030-1267835. Epub 2010 Nov 2.

Abstract

The aim of this study is to review our 9-year experience with deep inferior epigastric perforator (DIEP) breast reconstructions to help others more easily overcome the pitfalls we experienced. A chart review was conducted for all 543 patients who had 622 DIEP breast reconstructions in our clinic between January 2000 and January 2009. In this time, there were an additional 28 superior gluteal artery perforator and 25 superficial inferior epigastric artery reconstructions, bringing the total free flap reconstructions to 675. In the early years, the success rate was 90.7%, the average operative time was 7 hours and 18 minutes, and the complication rate was 33.3%; these have improved to 98.2%, 4 hours and 8 minutes, and 19.3%, respectively. We describe our selection criteria, preoperative vascular mapping, surgical techniques, and postoperative monitoring as they relate to these improvements in outcome, operative time, and complications. The DIEP flap is a safe and reliable option in breast reconstructions. By acquiring experience with the flap and introducing new and improving existing techniques we have improved the ease of the procedure and the success rate and have shortened the operative time.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Muscles / blood supply
  • Abdominal Muscles / transplantation*
  • Adult
  • Aged
  • Anastomosis, Surgical / methods
  • Breast Neoplasms / surgery
  • Chi-Square Distribution
  • Cohort Studies
  • Epigastric Arteries / surgery*
  • Female
  • Follow-Up Studies
  • Free Tissue Flaps / adverse effects
  • Free Tissue Flaps / blood supply*
  • Graft Rejection
  • Graft Survival
  • Humans
  • Mammaplasty / adverse effects
  • Mammaplasty / methods*
  • Mastectomy / methods
  • Middle Aged
  • Patient Selection
  • Postoperative Care / methods
  • Postoperative Complications / physiopathology
  • Retrospective Studies
  • Risk Assessment
  • Tomography, X-Ray Computed
  • Wound Healing / physiology
  • Young Adult