Venous outflow augmentation protects against fat necrosis in the DIEP flap breast reconstruction: A retrospective analysis.

[BACKGROUND] In the deep inferior epigastric perforator (DIEP) flap breast reconstruction, fat necrosis is a common and distressing complication for patients. While venous outflow augmentation using the superficial inferior epigastric vein (SIEV) has been suggested to improve some perfusion-related outcomes, its effect on fat necrosis remains insufficiently substantiated.

[METHODS] A retrospective review was conducted of unilateral, unipedicled DIEP flap breast reconstructions performed between 2012 and 2023 at a tertiary centre in London, United Kingdom. Patients were categorised based on SIEV venous augmentation status, and the incidence of postoperative clinical fat necrosis was recorded. Univariable and multivariable logistic regression models assessed the relationship between fat necrosis and SIEV augmentation, as well as patient, surgical and perfusion-related factors.

[RESULTS] The total cohort included 119 patients (119 flaps). Of the total flaps, 58.8% received venous augmentation with the SIEV. Fat necrosis occurred in 16.8% of the total cases. Patients in the SIEV-augmented group experienced significantly lower fat necrosis rates compared to controls (10.0% vs. 26.5%, respectively; P = 0.025). Multivariable analysis further demonstrated a protective effect from SIEV augmentation against fat necrosis (adjusted odds ratio 0.33, 95% confidence interval 0.12-0.95; P = 0.039).

[CONCLUSIONS] In the present cohort of DIEP flap breast reconstructions, venous augmentation using SIEV was a significant independent protective factor against fat necrosis. While prospective studies are necessary to validate this relationship, this technique may be considered as part of routine surgical practice in eligible cases.