Download PDF
J Reconstr Microsurg 2024; 40(07): 504-510
DOI: 10.1055/a-2238-8399
Original Article

DIEP Donor Site Satisfaction between Patients with and without History of Pregnancy

David Chon-Fok Cheong
1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Allen Wei-Jiat Wong 
1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
3   Plastic Reconstructive and Aesthetic Service, Sengkang General Hospital, Singapore
,
Shu-Wei Kao
1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
,
Shu-Ying Chang
2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
4   Division of General Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
,
Jung-Ju Huang 
1   Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background With the success of free autologous breast reconstruction, the abdominal donor site is now an important consideration, especially in patients of childbearing age. In our institution, there are increasing patients who have successfully undergone the deep inferior epigastric artery perforator (DIEP) flap despite previous pregnancy. This study aims to answer questions on the effect of the donor site on pregnancy and vice versa.

Methods A retrospective cohort study was conducted to identify breast cancer patients who received a free DIEP flap for breast reconstruction from January 2018 to August 2020. Patients were allocated to two groups according to whether they had prior pregnancies with successful deliveries. Demographics, flap-related parameters, surgical outcomes on breast and abdomen, and patient-reported outcome (Breast-Q questionnaire) were analyzed. Patients were excluded if follow-up time was less than 1 year, or if there was incomplete medical records or Breast-Q replies.

Results Ninety-nine of 116 patients had had successful pregnancies with delivery, 17 of them remained nulliparous. No statistically significant differences existed between groups regarding demographic data, flap-related parameters, surgical outcomes on breast and abdomen. Nulliparous patients exhibited significantly lower score in physical well-being in the abdomen domain compared with delivery-experienced patients (62.1 vs. 73.4, p = 0.025). Significantly, nulliparous patients felt more tightness and pulling of the abdominal wall than the delivery-experienced patients (2.9 vs. 3.7; p = 0.05 and 3.5 vs. 4.0; p = 0.04).

Conclusion Free DIEP flap can be transferred safely in nulliparous patients despite a slight increase in abdominal tightness and abdominal pulling. Precise flap design and surgical approaches may help to minimize the abdominal discomfort especially on young, normal body mass index, and nonchildbearing patients.

Keywords

DIEP flap - breast reconstruction - donor site - young breast cancer - Breast-Q

Ethics Approval and Consent to Participate

This study was performed in-line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board of Chang Gung Medical Foundation (IRB number: 202101923B0).


Consent for Publication

Informed consent was obtained from the patient included in this study.


Availability of Data and Materials

The raw datasets generated within this study are available from the corresponding author on reasonable request.




Publication History

Received: 10 October 2023

Accepted: 18 December 2023

Accepted Manuscript online:
04 January 2024

Article published online:
02 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kashyap D, Pal D, Sharma R. et al. Global increase in breast cancer incidence: risk factors and preventive measures. BioMed Res Int 2022; 2022: 9605439
    CrossrefPubMedSearch in Google Scholar
  • 2 Taiwan Cancer Registry Center. Incidence and mortality rates for top 10 cancers in Taiwan. 2023 Accessed September 18, 2023 at: https://twcr.tw/?page_id=1855&lang=en
    PubMedSearch in Google Scholar
  • 3 Chen YC, Su SY, Jhuang JR. et al. Forecast of a future leveling of the incidence trends of female breast cancer in Taiwan: an age-period-cohort analysis. Sci Rep 2022; 12 (01) 12481
    CrossrefPubMedSearch in Google Scholar
  • 4 Sopik V. International variation in breast cancer incidence and mortality in young women. Breast Cancer Res Treat 2021; 186 (02) 497-507
    CrossrefPubMedSearch in Google Scholar
  • 5 Chen SC, Lin CW, Lee PF, Chen HL, Ho CC. Anthropometric characteristics in Taiwanese adults: age and gender differences. Int J Environ Res Public Health 2021; 18 (14) 7712
    CrossrefPubMedSearch in Google Scholar
  • 6 Santanelli F, Longo B, Cagli B, Pugliese P, Sorotos M, Paolini G. Predictive and protective factors for partial necrosis in DIEP flap breast reconstruction: does nulliparity bias flap viability?. Ann Plast Surg 2015; 74 (01) 47-51
    CrossrefPubMedSearch in Google Scholar
  • 7 Jeong W, Lee S, Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast 2018; 38: 45-51
    CrossrefPubMedSearch in Google Scholar
  • 8 He WY, El Eter L, Yesantharao P. et al. Complications and patient-reported outcomes after TRAM and DIEP flaps: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2020; 8 (10) e3120
    CrossrefPubMedSearch in Google Scholar
  • 9 Patel KM, Basci D, Nahabedian MY. Multiple pregnancies following deep inferior epigastric perforator (DIEP) flap breast reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (03) 434-436
    CrossrefPubMedSearch in Google Scholar
  • 10 Alipour S, Eskandari A. Systematic review of effects of pregnancy on breast and abdominal contour after TRAM/DIEP breast reconstruction in breast cancer survivors. Breast Cancer Res Treat 2015; 152 (01) 9-15
    CrossrefPubMedSearch in Google Scholar
  • 11 Moshrefi S, Kanchwala S, Momeni A. Should planned/desired pregnancy be considered an absolute contraindication to breast reconstruction with free abdominal flaps? A retrospective case series and systematic review. J Plast Reconstr Aesthet Surg 2018; 71 (09) 1295-1300
    CrossrefPubMedSearch in Google Scholar
  • 12 Mauch JT, Kozak GM, Rhemtulla IA. et al. Does pregnancy predict incisional hernia repair after abdominally based autologous breast reconstruction? A retrospective review of 890 free flaps. Plast Reconstr Surg 2020; 145 (05) 909e-916e
    CrossrefPubMedSearch in Google Scholar
  • 13 Fu A, Liu C. Is pregnancy following a TRAM or DIEP flap safe? A critical systematic review and meta-analysis. Aesthetic Plast Surg 2021; 45 (06) 2618-2630
    CrossrefPubMedSearch in Google Scholar
  • 14 Hivelin M, Soprani A, Schaffer N, Hans S, Lantieri L. Minimally invasive laparoscopically dissected deep inferior epigastric artery perforator flap: an anatomical feasibility study and a first clinical case. Plast Reconstr Surg 2018; 141 (01) 33-39
    CrossrefPubMedSearch in Google Scholar
  • 15 Shakir S, Spencer AB, Kozak GM, Nathan SL, Soriano IS, Kanchwala SK. Laparoscopically assisted DIEP flap harvest minimizes fascial incision in autologous breast reconstruction. Plast Reconstr Surg 2020; 146 (03) 265e-275e
    CrossrefPubMedSearch in Google Scholar
  • 16 Shakir S, Spencer AB, Piper M, Kozak GM, Soriano IS, Kanchwala SK. Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: a single surgeon retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74 (06) 1203-1212
    CrossrefPubMedSearch in Google Scholar
  • 17 Lee MJ, Won J, Song SY. et al. Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: a retrospective matched study. Front Oncol 2022; 12: 989231
    CrossrefPubMedSearch in Google Scholar
  • 18 Tsai CY, Kim BS, Kuo WL. et al. Novel port placement in robot-assisted DIEP flap harvest improves visibility and bilateral DIEP access: early controlled cohort study. Plast Reconstr Surg 2023; 152 (04) 590e-595e
    CrossrefPubMedSearch in Google Scholar
  • 19 Nagarkar P, Lakhiani C, Cheng A, Lee M, Teotia S, Saint-Cyr M. No-drain DIEP flap donor-site closure using barbed progressive tension sutures. Plast Reconstr Surg Glob Open 2016; 4 (04) e672
    CrossrefPubMedSearch in Google Scholar
  • 20 Kim J, Lee KT, Mun GH. Safety of drainless donor closure in DIEP flap-based breast reconstruction: a prospective analysis using ultrasound. J Reconstr Microsurg 2024; 40 (02) 123-131
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Lakatta AC, Steppe C, Teotia SS, Haddock NT. Reduction in seroma rate following deep inferior epigastric perforator flap with umbilectomy utilizing progressive tension sutures. J Reconstr Microsurg 2024; 40 (02) 118-122
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Abesamis GM, Chopra S, Vickery K, Deva AK. A comparative trial of incisional negative-pressure wound therapy in abdominoplasty. Plast Reconstr Surg Glob Open 2019; 7 (05) e2141
    CrossrefPubMedSearch in Google Scholar
  • 23 Tran BNN, Johnson AR, Shen C, Lee BT, Lee ES. Closed-incision negative-pressure therapy efficacy in abdominal wall reconstruction in high-risk patients: a meta-analysis. J Surg Res 2019; 241: 63-71
    CrossrefPubMedSearch in Google Scholar
  • 24 Morris MP, Christopher AN, Patel V, Onyekaba G, Broach RB, Fischer JP. Negative pressure wound therapy after abdominal body contouring: a comparative matched analysis of outcomes and cost. Plast Surg (Oakv) 2022; 30 (04) 360-367
    CrossrefPubMedSearch in Google Scholar
  • 25 Hsiao HY, Hsieh WC, Chang FC. et al. The effect of negative pressure on wound healing and regeneration in closed incisions under high tension: evidence from animal studies and clinical experience. J Clin Med 2022; 12 (01) 106
    CrossrefPubMedSearch in Google Scholar
  • 26 Jo T, Jeon DN, Han HH. The PAP flap breast reconstruction: a practical option for slim patients. J Reconstr Microsurg 2022; 38 (01) 27-33
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Lu J, Zhang KK, Graziano FD, Nelson JA, Allen Jr RJ. Alternative donor sites in autologous breast reconstruction: a clinical practice review of the PAP flap. Gland Surg 2023; 12 (04) 516-526
    CrossrefPubMedSearch in Google Scholar
  • 28 Haddock NT, Lakatta AC, Teotia SS. Bilateral LAP flaps for breast reconstruction: a perforator classification system. Plast Reconstr Surg 2023 . Doi:10.1097/PRS.0000000000011002
    PubMedSearch in Google Scholar