November 06, 2017
1 min read

DIEP, SIEA flaps may be preferable in abdominal-based breast reconstruction

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Improved abdominal outcomes were reported for deep inferior epigastric perforator and superficial inferior epigastric artery flaps compared with both pedicled and free transverse rectus abdominis myocutaneous flaps in abdominal-based breast reconstruction, according to recent findings.

The researchers compared abdominal donor-site and breast complication rates along with patient-reported outcomes for the four flap types in a cohort of patients from 11 centers. One-year follow-up data were available for 720 patients, while 2-year follow-up data were available for 587 patients.

At 2 years, donor-site complications were higher with superficial inferior epigastric artery (SIEA) flaps compared with deep inferior epigastric perforator (DIEP) flaps (OR = 2.7; P = .001).

However, 1-year findings indicated that SIEA bested DIEP based on BREAST-Q abdominal physical well-being score (mean difference: 4.72; P = .053, on a scale from 0 to 100). By 2 years, this difference was nonsignificant.

Other 2-year results indicated that DIEP scored 7.2 points higher than pedicled transverse rectus abdominis myocutaneous (TRAM) on the BREAST-Q abdominal physical well-being scale (P = .006). SIEA scored 7.8 points higher than pedicled TRAM (P = .03) on this scale at 2 years. In addition, free TRAM scored 4.9 points lower than DIEP on this scale (P = .04).

Significantly lower abdominal physical well-being scores were reported among patients undergoing bilateral reconstruction compared with unilateral reconstruction, according to the findings.

“While all abdominal-based flaps are viable breast reconstruction options, DIEP and SIEA flaps are associated with a higher abdominal physical well-being than pedicled TRAM and free TRAM flaps,” the researchers concluded. “Although SIEA flaps offer the advantage of not violating the fascia, higher rates of donor-site complications may diminish patient satisfaction.” – by Rob Volansky

Disclosure: The authors report that the BREAST-Q is owned by Memorial Sloan Kettering Cancer Center and the University of British Columbia. Additionally, one author is a co-developer of the BREAST-Q and receives royalties when it is used in for profit industry-sponsored clinical trials.