Donor Site Outcomes Following Autologous Breast Reconstruction with DIEP Flap: A Retrospective and Prospective Study in a Single Institution

Background: The deep inferior epigastric perforator artery (DIEP) free flap is the most commonly performed autologous breast reconstruction. Despite the relative reduction in donor site complications compared to nonmuscle-sparing options, there is still high morbidity associated with this surgery. The purpose of this study is to compare outcomes and complications at our institution and to discuss potential quality improvement initiatives. Methods: A retrospective cohort study was performed looking at patients who underwent delayed or immediate autologous breast reconstruction with a DIEP flap over a 6-year period (2015-2021) at our institution. Complication rates for abdominal infection, seroma, hematoma, wound dehiscence, delayed wound healing, umbilical necrosis, subjective abdominal weakness, abdominal bulge, and hernia were calculated. Additionally, a prospective cohort study was conducted using a portable ultrasound device to detect postoperative changes in the abdominal donor site, including fluid collections and postoperative edema. Results: One hundred seventeen patients underwent autologous breast reconstruction with a DIEP-free flap. Forty-one percent of patients experienced 1 or more donor site complications. Complication rates were 16.2%, 12.8%, 1.7%, 15.4%, 8.5%, 4.3%, 0%, 10.3%, and 2.6%, respectively, for the list above. There was a higher proportion of complications in patients who smoked within the past 3 months and those who had a body mass index (BMI) between 35 and 39.9, although this was not statistically significant. Bilateral reconstructions had higher rates of umbilical necrosis (24.5% vs 7.8%) and wound dehiscence (9.4% vs 0%) compared to unilateral. Twenty-one patients were included in the prospective analysis. No significant changes in abdominal wall edema were found. Twenty-four percent of the patients had detectible collections on ultrasound, and these were associated with wound dehiscence and the need for debridement. Discussion: Our institutional abdominal donor site complication rates in DIEP reconstruction patients are higher than those published in the literature. Similar complication rates were identified regardless of smoking status, BMI, and unilateral/bilateral surgery. Quality improvement initiatives could be considered and implemented to reduce future complications.