Corrective surgery following deep inferior epigastric perforator (DIEP) flap breast reconstruction in irradiated vs non-irradiated patients.

Abstract

Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is the standard for autologous breast reconstruction. Secondary corrective procedures are often performed to refine contour, symmetry and reconstructive completion. The association between history of radiation therapy and impact of these interventions remains poorly defined. Therefore, we evaluated the incidence, types and complications of recipient-site corrective surgeries following DIEP breast reconstructions in irradiated and non-irradiated patients. A multicentre retrospective cohort study was conducted using a database of patients who underwent successful DIEP flap breast reconstruction between January 2010 and December 2024 at three Dutch centres. Corrective procedures included nipple reconstruction, contralateral breast reduction, scar and dog ear correction and fat grafting. Mixed-effect models were performed to identify factors that were associated with the frequency of corrective procedures. Among 2211 DIEP flaps, 717 (32.4%) were performed in irradiated patients. The observed mean number of corrective procedures per flap was similar between the irradiated and non-irradiated patients (2.83 vs 2.84). After adjustment for reconstruction timing (immediate vs delayed) and reconstruction type (unilateral vs bilateral), irradiated patients underwent slightly fewer corrective procedures (adjusted estimate β = -0.144, p = 0.033), although the absolute difference was clinically negligible. Complications following corrective surgery were rare in both the groups. Multivariable analyses identified increasing age, immediate reconstruction, university hospital setting and complications after initial reconstruction as independent predictors of the number of corrections. A history of radiation therapy does not clinically influence the frequency of corrective procedures or incidence of complications following corrective procedures after DIEP flap breast reconstruction. These findings indicate that the treatment setting, patient- and treatment-related variables significantly influenced the number of corrections performed. Importantly, the number of corrections does not necessarily reflect the final aesthetic quality of the reconstruction.