Complications After Deep Inferior Epigastric Perforator Flap Breast Reconstruction for Nipple-Sparing Mastectomy: A Series of 380 Flaps.

[BACKGROUND] Nipple-sparing mastectomy (NSMs) and the deep inferior epigastric perforator (DIEP) flap for breast reconstruction represent the latest evolutions of breast and reconstructive surgery, with resemblance to the aesthetics and feel of the natural breast without needing additional nipple reconstruction or tattooing. Despite clinical adoption of these advances, current literature of autologous reconstruction after NSM remains limited. Herein, we classify the incidence and predictors for the most common complications in patients undergoing NSM and DIEP flap reconstruction over a 10-year period.

[METHODS] This is a retrospective review of all patients receiving uni- or bilateral NSMs with DIEP flap breast reconstruction by the senior author between July 2013 and November 2022. Complications included flap issues, infection, hematoma, and wound healing problems within 90 days.

[RESULTS] Two hundred fourteen patients had post-NSM DIEP reconstruction for 380 breasts. The average age at reconstruction was 49.98 (SD 10.0). Sixteen (4.2%) flaps required a reoperation during the same admission: 13 were due to a hematoma, 2 were due to flap thrombosis, and 1 was due to venous congestion. No flaps were lost. On multivariate analysis, body mass index > 25 kg/m2 and tobacco use were associated with breast and abdominal complications. Delayed-immediate reconstruction was protective against breast complications (odds ratio 0.16, P = 0.001).

[CONCLUSION] In our series of 380 DIEP flaps after NSM, we present a major donor site complication rate of 5.9% and a major recipient site complication rate of 16.3%. Body mass index and tobacco use are associated with breast and abdominal complications. Delayed-immediate reconstruction has a protective effect on breast complications.