Safety of Combined Deep Inferior Epigastric Artery Perforator Flaps and Gynecologic Procedures.

Abstract

Background: Multidisciplinary breast cancer treatment is essential. For some patients, risk-reducing gynecologic procedures are a necessary addition. The deep inferior epigastric artery perforator (DIEP) flap for autologous breast reconstruction shares a common abdominal surgical site with open gynecological procedures, but the impact of concurrent surgery remains to be seen.

Methods: A retrospective chart review of all patients undergoing DIEP flap breast reconstruction with and without gynecologic procedures at our institution from 2017 to 2022 was performed.

Results: Patients undergoing combined DIEP flaps and gynecologic procedures were younger (44.6 vs 51.9, P = 0.0066) and more likely to undergo bilateral (88.2% vs 44.3%, P = 0.0004) and prophylactic (35.3% vs 9.7%, P = 0.0013) mastectomies. Concurrent surgery was associated with longer operating time (500 vs 401 minutes, P = 0.0039), greater estimated blood loss (299.1 vs 150.8 cc, P < 0.000001), but unchanged length of stay (2.59 vs 2.81 days, P = 0.51) and opioid usage (115.2 vs 122.2 morphine milligram equivalent, P = 0.80). There were increased rates of hernia and bulge in the combined procedure cohort (17.6% vs. 5.5%, P = 0.0464). Rates of flap loss, infection, and wounds were similar between the 2 cohorts. Total cost increased ($33,700 vs $28,416, P = 0.0231) but cost margin was unchanged.

Conclusions: Combining DIEP flap and gynecologic procedures is safe and well tolerated without differences in flap loss, length of stay, opioid use, or cost margins. However, operative time and postoperative hernia/bulge rates are higher. Plastic surgeons must be vigilant with patient selection and with abdominal wall preservation when considering combining abdominally based autologous breast reconstruction and gynecologic procedures.