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Impact of Flap Laterality on Outcomes in DIEP Flap Breast Reconstruction: A Matched Cohort Analysis
Patrick S. Potoczak, Noam Yanay, Rachel E. Schafer, Madeleine Blazel, Rommy Obeid, Riley Marlar MD, Diane Jo, Steven Bernard MD, Graham Schwarz MD, Risal Djohan MD, Raffi Gurunian MD, Sarah N. Bishop MD
Cleveland Clinic
2025-01-10
Presenter: Patrick S. Potoczak
Affidavit:
approval has been granted.
Director Name: Raymond Isakov
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Internal mammary vessels (IMVs) are commonly used as recipient vessels in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Prior studies suggest that left IMVs may be smaller, potentially increasing the risk of venous complications. However, no matched cohort study has comprehensively evaluated differences in outcomes between left and right flaps. This study investigates the impact of flap laterality on surgical outcomes.
Methods: A matched cohort analysis was conducted on 358 patients who underwent bilateral DIEP flap breast reconstruction at a tertiary-care institution between 2016 and 2022. Patient demographics, medical history, surgical details, and postoperative complications were compared between left and right flaps. Statistical tests, including Wilcoxon rank-sum, Chi-squared, and Fisher's exact tests, were used to evaluate differences.
Results: Among the 358 patients (median age 51 years, BMI 29.1), 84% had breast cancer, and 44% received radiation therapy. The median surgery duration was 9.46 hours. Venous coupler size was significantly smaller for left flaps (median 2.50 mm) compared to right flaps (median 3.00 mm, p < 0.001). Despite this variation, the overall complication rate was 20%, with no statistically significant differences in the rates of complications between left and right flaps (p > 0.05).
Conclusions: This matched cohort study demonstrates that, despite differences in venous coupler size, there are no significant differences in postoperative complication rates between left and right DIEP flaps. These findings provide robust evidence supporting the reliability of both flaps as reconstructive options and highlight the utility of matched analyses in minimizing confounding variables.
