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Predictors of complications in autologous breast reconstruction using deep inferior epigastric perforator flaps
Shannon S. Wu BA; Charlie Raymer MD; Rachel Schafer BS; August Culbert BS; Risal Djohan MD; Steven Bernard MD; Raymond Isakov MD; Graham Schwarz MD; Sarah Bishop MD; Raffi Gurunian MD
Cleveland Clinic
2022-01-14
Presenter: Charles Raymer
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. This work represents the original work of the authors.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Deep inferior epigastric perforator (DIEP) flaps are the gold-standard for autologous breast reconstruction following mastectomy. However, risk factors for complications are not well characterized and are needed to facilitate shared decision-making. This study aimed to explore risk factors in a large, contemporary cohort.
Methods
This retrospective study included patients who underwent unilateral or bilateral DIEP flaps between 2016-2020 at a single-center institution. Demographic, treatment, and outcome characteristics were evaluated in univariate and multivariate regression models for postoperative complications.
Results
In total, 802 DIEP flaps were performed in 524 patients (mean age 51.2±9.6, BMI 29.3±4.5). Most (86.5%) patients had breast cancer, and 15.1% were BRCA-positive. There were 282 (53.1%) delayed and 242 (46.2%) immediate reconstructions, and 278 (53.1%) bilateral and 246 (46.9%) unilateral reconstructions. Overall complications occurred in 92 (17.6%) patients, including flap failure (6.5%), infection (3.2%), hematoma (2.9%), abdominal wound dehiscence (0.6%), flap necrosis (0.4%), breast wound dehiscence (0.4%), and abdominal seroma (0.4%). Reoperation was required in 75 (14.3%) patients. Prolonged surgical time (OR=1.15, p<0.001), immediate reconstruction (OR=1.80, p=0.033), and higher BMI (OR=1.05, p=0.071) predicted overall complications.
Conclusions
Prolonged operating time, immediate reconstruction, and higher BMI predicted overall complications. For each additional hour of surgical time, the risk of developing any complication increased by nine-fold.
Immediate reconstructions were at higher risk of overall complications and reoperation, but not flap-specific complications. Age, smoking, tamoxifen or aromatase use, and laterality were not significantly associated with adverse outcomes. Our findings contribute to the evidence base to inform shared decision-making for patients seeking breast reconstruction.
