Surgical revision in case of DIEP failure in breast reconstruction

Introduction. - Immediate or delayed breast reconstruction by deep inferior epigastric perforant flap (DIEP) is a frequent and widespread autologous breast reconstruction technique that presents a risk of failure inherent in its microsurgical nature. The main objective was to evaluate the interest of surgical revision in case of DIEP failure, the secondary objective was to evaluate the consequences of surgical revision on the subsequent management. Materials and methods. - This is a retrospective monocentric and single-operator analytical study of 167 unilateral DIEPs carried out from 2008 to 2016. Two groups were compared: success of DIEP without revision versus DIEP requiring a revision that resulted in success or failure. After analyzing the failure and recovery rates of DIEP, we compared the transfusion rate, total operating time, hospitalization time, and final breast reconstruction in the two groups. Results. - One hundred and sixty-seven DIEPs were performed from 2008 to 2016 in 167 women, 18 revisions were reported (10.7%), 12 revisions were successfully reported (7.2%) 6 failures were reported after revision (3.6%). Surgical revision allows the flap to be rescued in 67% of cases. Revision increases the risk of blood transfusion by a factor of 12 (OR = 12.24 [95% CI = 3.74-43.17] P < 0.05). Revision or failure doubles the total operating time (281.8 min [170-570] vs. 577.8 min [285-860] P < 0.05) and increases hospitalization time by 2.5 days compared to DIEP's initial success (5.74 days [4-9] vs. 8.33 days [5-17] P < 0.05). Fifty percent of patients choose another type of breast reconstruction after DIEP failure. Conclusion. - DIEP is a reliable microsurgical breast reconstruction technique, failure can be prevented in two thirds of cases by monitoring and early reoperation. (C) 2019 Elsevier Masson SAS. All rights reserved.