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Characterization of patient demographics and safety outcomes in immediate or delayed deep inferior epigastric perforator flap breast reconstruction
Rachel E. Schafer, Shannon S. Wu, Priya Shukla, Madeleine Blazel, Steven Bernard MD, Graham Schwarz MD, Risal Djohan MD, Sarah N. Bishop MD, Raffi Gurunian MD
Department of Plastic Surgery, Cleveland Clinic
2023-01-14
Presenter: Rachel E Schafer
Affidavit:
I approve of the breakdown of work responsibilities listed below for Rachel Schafer.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Deep inferior epigastric perforator (DIEP) flap reconstruction may occur immediately after mastectomy procedures or be delayed and performed during a separate operation. This study sought to differentiate population characteristics of patients who undergo immediate versus delayed DIEP flap breast reconstruction and assess the safety profiles of these surgeries.
Methods: This retrospective study included patients who underwent DIEP breast reconstruction between January 2016 and July 2022 at a tertiary-care, academic institution. Demographics and outcomes were compared using two-sample t-test or Chi-square analysis.
Results: Of the 669 patients included, 274 (41.0%) patients received immediate and 395 (59.0%) received delayed DIEP flap breast reconstruction. Overall, median age was 51 (IQR: 45, 58) years old and median BMI was 29.0 (IQR: 25.8, 32.3). Age, BMI, history of diabetes or tobacco use, intraoperative complications, readmission and reoperation rate were not significantly different between cohorts. However, immediate DIEP flap breast reconstructions had higher rates of overall postoperative complications (18% vs 12%, p=0.029) driven by higher rates of hematoma formation (4.4% vs 1.8%, p<0.001) compared to delayed DIEP flap breast reconstruction.
Conclusions: Immediate DIEP flap breast reconstruction was associated with higher rates of postoperative complications. Although breast reconstruction at time of mastectomy offers reduced cost, shorter overall recovery time, and fewer events requiring general anesthesia for patients, our findings contribute to evaluation of surgical candidacy for immediate versus delayed DIEP breast reconstruction.
