DIEP flap with implant placement has a favorable complication profile compared to implant-only or flap-only reconstruction.

Background: Hybrid deep inferior epigastric perforator (DIEP) flap and simultaneous silicone implant breast reconstruction procedures ("DIEP+I") have many conceptual advantages compared to either reconstruction method alone, but the outcomes of DIEP+I reconstruction have not yet been well studied. Therefore, the purpose of this study was to compare the outcomes of DIEP+I with implant-only and DIEP-only reconstruction.

Methods: A retrospective review was conducted of patients undergoing DIEP+I, implant-only, and DIEP-only breast reconstruction from 2019-2023 at a single institution. Demographics and complication rates were compared between groups.

Results: A total of 145 patients were included in the DIEP+I (N = 26), implant-only (N = 59), and DIEP-only (N = 60) groups. The DIEP+I group had a lower overall complication rate than implant-only reconstruction (18.4% vs 41.1%, P = 0.014), which was primarily due to the lower incidence of infections in the DIEP+I group (2.6% vs 22.2%, P = 0.006). Accordingly, DIEP+I reconstruction decreased the odds of infection by 90% (OR = 0.095, P = 0.024) compared to implant-only reconstruction. The DIEP+I group had similar rates of wound healing and implant-related complications compared to the implant-only and DIEP-only groups, and no patients in the DIEP+I group experienced flap loss.

Conclusion: DIEP+I breast reconstruction had a lower rate of infectious complications than implant-only reconstruction, and no higher rate of flap compromise or wound healing complications. This technique could be considered as a means of minimizing infection risk in patients with other risk factors who are seeking implant-based reconstruction, and of enhancing breast projection in patients who are seeking DIEP flap reconstruction.