Progression of the Deep Inferior Epigastric Perforator Flap Breast Reconstruction Technique at a Dedicated New Zealand Tertiary Plastic Surgery Unit: a Case Series Analysis

The deep inferior epigastric perforator (DIEP) flap is the gold standard in post-mastectomy breast reconstruction. Improved patient outcomes, reduced operating time and reduced complication rates are reportedly observed over consecutive DIEP series within surgical centres. The aim of this study is to investigate whether outcomes following DIEP flap reconstruction improve over time, by assessing two patient cohorts undergoing the procedure at a microsurgical unit seven years apart. A case analysis was undertaken to identify all patients who underwent primary DIEP flap reconstruction in 2011 and 2018. Outcomes recorded included clinic appointments, operating time, number of primary operations, additional operations and procedures, along with co-morbidities, BMI and radiotherapy rates. Immediate versus delayed and unilateral versus bilateral breast reconstruction was also recorded. Seven patients underwent primary DIEP reconstruction in 2011 and 29 in 2018. There was a significant reduction in additional operations performed in 2018 (p-value = 0.007) and a significant reduction in number of procedures (p-value = 0.043). When adjusted for an outlier, the total operating time for unilateral DIEP reconstruction was significantly shorter in 2018 (p-value = 0.018), along with reduced primary and total operating time for 2018 bilateral reconstructions. The 2018 cohort also had lower complication rates and fewer clinic appointments. This study illustrates how outcomes can improve with experience of DIEP flap reconstruction. The more complex DIEP flap requires investment in terms of skill acquisition and operative time, but is balanced by improvement in patient outcomes.