A systematic review of donor site aesthetic and complications after deep inferior epigastric perforator flap breast reconstruction

Abstract

Background: The deep inferior epigastric perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and muscle-sparing design. However, donor site results regarding aesthetic outcome are often less favorable. Despite several studies on surgical technique and improvements of flap harvest, only a small number of studies addressing donor site aesthetic exist.

Methods: A systematic review was performed on donor site aesthetic after DIEP flap harvest according to the PRISMA guidelines. Secondary interests were abdominal wall morbidity and complication rates in general. The following electronic databases were included to identify relevant studies: Medline, Embase, PubMed, Cochrane, and Web of Science.

Results: The search yielded 95 articles for full-text analysis, with only four key studies found on donor site aesthetic specifically. Regarding complication rates, the overall rate of abdominal hernia ranges from 0 to 7.1%. Abdominal bulging occurs in 2.3% to 33%. Besides abdominal wall integrity, wound dehiscence (12-39%), seroma (1-48%), hematoma (1-15%), infections (1-12%), fat necrosis (0-11%) and umbilical necrosis (2-3%) significantly impair donor site aesthetic.

Conclusions: This systematic review reveals that the topic of donor site aesthetic and potential improvement of results has largely been neglected in the past decade. This study provides a thorough evaluation of potential problems that plastic surgeons may encounter and includes recommendations to improve results.

Keywords: Breast neoplasms; mammaplasty; mastectomy; postoperative complications.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

The abdominal donor-site is shown in patients after breast reconstruction with DIEP. Photographs were taken 12 months postoperatively. The scar can either be acceptable and located in the lower part of the abdomen (A) or asymmetrical and show a visible step-off, hypertrophy, bulging and dog ears (B). DIEP, deep inferior epigastric perforator.

Figure 2

Systematic review.

Figure 3

Recommendations for DIEP flap harvest. (A) Preoperative flap design with a low scar 5–7 cm above the anterior vulva commissure. Cranially, the flap can be undermined in order to keep the incision low and to gain more volume; (B) the fascia incision should be kept as small as possible and the umbilicus should be located at least 7 cm above the final scar. DIEP, deep inferior epigastric perforator.

Figure 4

Limited incision (A) of the rectus fascia (5 cm) with harvest of a (B) single perforator DIEP flap with a long-intramuscular course. DIEP, deep inferior epigastric perforator.