Impact of postoperative complications on patient-reported outcomes in deep inferior epigastric perforator flap breast reconstruction.

[OBJECTIVE] This study aims to investigate the factors that influence the occurrence of complications following deep inferior epigastric perforator (DIEP) flap breast reconstruction, and to determine whether these complications have an impact on the patient's quality of life in China.

[METHODS] We collected clinical data from patients who underwent DIEP flap breast reconstruction at the Department of Breast, Affiliated Cancer Hospital of Zhengzhou University between December 2019 and December 2023. We analyzed the incidence of postoperative complications and their relationship with patient clinical data and surgical parameters. We also used the BREAST-Q 2.0 Chinese version scale to assess the impact of postoperative complications on patient-reported outcomes.

[RESULTS] A total of 109 patients underwent DIEP flap breast reconstruction, including 91 stage I reconstructions and 18 stage II reconstructions. Postoperative complications occurred in 26 cases (23.9%), including flap complications in 13 cases (11.9%) and abdominal donor-site complications in 13 cases (11.9%). Univariate and multivariate analyses showed that the overall incidence of complications was associated with high BMI and early surgery (P < 0.05). Flap complications were associated with high BMI, early surgery, and the use of internal mammary vascular branches as recipient vessels (P < 0.05). Abdominal complications were associated with previous abdominal surgery scars (P < 0.05). Approximately 20% of patients did not complete the BREAST-Q questionnaires (including the two patients who experienced total flap loss). BREAST-Q scores showed no significant differences between the surgical complication group and the no-complication group in terms of breast satisfaction, mental health, physical health-chest, physical health-abdomen, satisfaction with abdomen, sexual health, etc. (P > 0.05).

[CONCLUSION] Patients who underwent DIEP flap breast reconstruction revealed that high BMI, neoadjuvant therapy, and abdominal incision scars may influence postoperative complications. The limited follow-up data indicated that postoperative complications did not impact patient-reported outcomes.