Donor-site Morbidity After DIEAP Flap Breast Reconstruction

The deep inferior epigastric artery perforator (DIEAP) flap is a tissue flap from the lower abdomen. It has been developed over the past quarter of a century to become the mainstay of postmastectomy, autologous breast reconstruction. By harvesting a tissue flap from the lower abdomen, mostly containing skin and fat, the breast is reconstructed with tissue that resembles what has been surgically removed in the oncological treatment. The result is a natural, long-lasting breast reconstruction. The DIEAP flap harvesting does, however, carry the potential for harm. This doctoral thesis is aimed at investigating donor-site morbidity resulting from the DIEAP flap harvesting. Such iatrogenic injury to the abdominal wall has to be minimized, as patient safety is of prime importance in elective surgery, reflecting the axiom “Primum, non nocere” or “First, do no harm”. Donor-site morbidity after DIEAP flap breast reconstruction has been investigated through a prospective blood perfusion study of the undermined abdominal skin, a prospective computed tomography study of the abdominal wall, and a retrospective study surveying patients’ perspectives on abdominal outcomes. The doctoral thesis provides new insight into blood perfusion dynamics at the donor site, quantifies the relatively small postoperative effects on the morphology of the rectus abdominis muscles and abdominal wall, and finds that patients are generally satisfied with their postoperative abdomen. Overall, DIEAP flaps result in limited donor-site morbidity which for most patients does not outweigh the benefits of perforator flap breast reconstruction. The findings support the safety and adequacy of current practices for DIEAP flap breast reconstruction and provide tracks for future investigations