Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Optimizing DIEP Flap Insetting for Immediate Unilateral Breast Reconstruction: A Prospective Cohort Study of Patient-Reported Aesthetic Outcomes

Razzano, Sergio, M.D.(Hons.); Marongiu, Francesco, M.D.; Wade, Ryckie, M.Clin.Ed., M.R.C.S., F.H.E.A.; Figus, Andrea, M.D.(Hons.), Ph.D.(Hons.)

Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 261e-270e
doi: 10.1097/PRS.0000000000005277
Breast: Original Articles
Outcomes: Patient-Reported Health

Background: To improve the aesthetic outcome of deep inferior epigastric perforator (DIEP) flap breast reconstruction, flaps should be tailored to the patient’s characteristics. A single method of DIEP flap insetting will not suffice for all women seeking breast reconstruction. The authors share the outcomes of a prospective longitudinal study on DIEP flap insetting and present an algorithm for reconstruction.

Methods: Over 4 years, 70 consecutive immediate unilateral DIEP flap breast reconstructions were prospectively evaluated. DIEP insetting was based on the characteristics of the donor site and contralateral breast, according to the authors’ algorithm. Baseline and outcome data were collected. Aesthetic outcomes were evaluated by a panel of three independent assessors, and patient-reported outcomes were quantified using the BREAST-Q at 1 year after reconstruction.

Results: Seventy women underwent reconstruction. There were no total or partial flap failures, four cases of fat necrosis, and 14 revision operations. Women reported a mean overall BREAST-Q score of 82 of 100, representing excellent satisfaction but poor satisfaction with sexual well-being. BREAST-Q scores were not associated with age or body mass index. Fat necrosis reduced satisfaction with the chest (absolute mean reduction, 13; 95 percent CI, 8 to 18; p = 0.002). Independent assessors scored the outcomes favorably, but there was no agreement between surgeons, nurses, and lay assessors.

Conclusions: The authors’ algorithm can support surgeons in selecting individually tailored DIEP flap insetting to achieve excellent aesthetic outcomes. Further research is needed as to the relevance of scores from BREAST-Q in relation to interventions.


Evidence-Based Outcomes Article.

Norwich and Leeds, United Kingdom; and Cagliari, Sardinia, Italy

From the Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust; the Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust; the Faculty of Medicine and Health Sciences, University of Leeds; and University of Cagliari, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit, University Hospital Duilio Casula.

Received for publication September 17, 2017; accepted July 9, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Andrea Figus, M.D.(Hons.), Ph.D.(Hons.), Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit, University Hospital Duilio Casula, SS554, Monserrato, 09100, Cagliari, Sardinia, Italy,

Copyright © 2019 by the American Society of Plastic Surgeons