Background:
Breast cancer is the most common
cancer affecting women worldwide. In Germany, in almost 70% of cases, women require a complete
mastectomy and wish for
breast reconstruction which is especially difficult when the breast was previously irradiated. The
DIEP flap is then the gold standard for autologous
breast reconstruction and shows an overall low complication rate. This study aims to underline the safety of the procedure yet point out potential risk factors for flap edge and
fat necrosis in a retrospective series of 1274
DIEP flaps in our center. Patients and Methods: 1274 autologous
breast reconstructions with the
DIEP flap were performed in 1124 patients between July 2004 and December 2014 in our department. Retrospective risk factor analysis included age, BMI, smoking,
chemotherapy and/or
radiotherapy and comorbidities. Mean follow-up constituted out of 24 months. Results: Out of 1274 free
DIEP flap
breast reconstructions, 150 were bilateral reconstructions. In 785 cases the primary indication was previous
mastectomy, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Patients with a higher BMI and smokers had significantly higher complication rates than the rest of the cohort. Elderly patients ( 65 years), patients with diabetes and ones who had undergone chemo-/
radiotherapy did not present with higher complication rates. Conclusions: The
DIEP flap surgery is a well-established method for autologous
breast reconstruction with a low complication rate. Yet patient characteristics in terms of risk factors need to be taken into account for result prognosis and satisfactory long-term reconstructive results.