Breast Reconstruction After Mastectomy Using a Deep Inferior Epigastric Perforator (DIEP) Flap: Clinical and Medico-Legal Insights From a Four-Year Study.

[AIMS] Breast reconstruction after mastectomy is nowadays a gold standard in therapy of breast cancer patients. Free deep inferior epigastric perforator (DIEP) flap reconstruction is a favorable method when traditional implants fail or are not viable, especially after radiotherapy. The aim of this paper is to present the results of a case series study of 40 patients operated on with DIEP flap from January 2020 to October 2023, in Plastic, Reconstructive and Aesthetic Surgery Department in Nicosia General Hospital, Cyprus, complications and wound management, reoperation rates, as well as to examine these results from a medico-legal perspective, to highlight the most significant medico-legal implications of this demanding, surgical procedure.

[METHOD] Forty patients were included in this study with unilateral or bilateral free DIEP reconstruction, from January 2020 to October 2023, in Plastic, Reconstructive and Aesthetic Surgery Department in Nicosia General Hospital, Cyprus. Demographics, preoperative conditions, hospitalization days, complication rates, and reoperation rates were analyzed as well as satisfaction rates of patients were evaluated.

[RESULTS] This original article highlighted a number of issues of strict medico-legal interest, including the importance of informed consent in the case of demanding procedures for reconstructive and esthetic purposes, the assessment of standards of care in the evaluation of medical liability, and the existence of an obligation of means or results on the reconstructive surgeon's part.

[CONCLUSIONS] DIEP breast reconstruction after mastectomy is a challenging but safe and with well postoperative results operation that should be employed in cases traditional implant reconstruction fail or not feasible due to other parameters. Innovative and demanding reconstructive, esthetic surgery procedures are characterized by particularly significant aspects of medico-legal interest, which deserve careful consideration by both the scientific community and patients involved.