Unilateral autologous breast reconstruction with unipedicled and bipedicled deep inferior epigastric artery perforator flap: A review of 168 cases over 3 years

Background: Harvesting a DIEP flap based on bipedicled perforators can enhance vascular perfusion, which can reduce complication rates, minimize fat necrosis, and flap failure. This study summarizes our experience with using unipedicled and bipedicled DIEP flaps for breast reconstruction. Patients and Methods: A total of 168 consecutive patients undergoing unilateral breast reconstruction with DIEP flaps over a 3-year period were retrospectively reviewed. Primary microvascular anastomoses were performed to the thoracodorsal vessels in both unipedicled and bipedicled DIEP groups. In bipedicled DIEP flap cases, additional secondary microvascular anastomoses were performed either by extraflap or intraflap options. Clinical characteristics and outcomes were recorded. Results: Unipedicled (n = 89; 53%) and bipedicled flaps were used. Both groups were comparable for mean age, diabetes mellitus, hypertension, smoking, and chemotherapy. BMI was 24.9 ± 3.6 in the unipedicled group and 22.8 ± 2.9 in the bipedicled group (p <.001). The surgical duration was longer in bipedicled group (367 ± 86.5 minu vs 403.7 ± 65.6 min, p <.05) but incidence of fat necrosis decreased in the bipedicle group (24 patients [27%] vs. 7 patients [8.9%] p <.05). There was no flap loss or instance of abdominal hernia in any group. Conclusions: The bipedicled DIEP flaps may be a feasible option for large breast reconstruction in thin patients. However, the additional microsurgical technical complexity and longer operative time must be considered.