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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.
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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.

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