Deep inferior epigastric perforator flap breast reconstruction after mastectomy : An analysis of long-term outcomes and potential complications

This thesis evaluated the long-term effects and satisfaction with outcomes following deep inferior epigastric perforator (DIEP)-based breast reconstruction after mastectomy Paper I is a retrospective cohort study of women who received a unilateral DIEP in 2000–2009 (n = 225) in Uppsala. These women were compared with individually matched women who underwent mastectomy without autologous reconstruction (n = 450). Recurrence and survival were primary endpoints. Both groups demonstrated a similar risk of recurrence. However, the DIEP group had a significant survival advantage not persisting after adjusting for tumor characteristics. Paper II examined whether breast reconstruction using a DIEP flap is associated with volume changes or arm lymphedema symptoms. It hypothesized that compared with DIEP reconstructions without using the cephalic vein (CV), that using CV is not associated with ipsilateral lymphedema. Patients completed the Lymphedema Quality of Life Inventory questionnaire to assess postoperative lymphedema symptoms. CV was found to be potentially useful as an extra venous outflow in DIEP breast reconstructions without increasing the risk of ipsilateral arm swelling or lymphedema symptoms. Paper III evaluated the aesthetic outcome and satisfaction with the appearance of abdominal-based breast reconstruction in the long-term. Patients responded to the postoperative BREAST-Q model, and their photographs were at a mean of 11 years postoperatively. The outcomes of the BREAST-Q and available normative scales were compared. The photographs were assessed by two panels, comprising eight professionals and lay individuals, respectively. According to patients, professionals, and lay observers, abdominal-based breast reconstructions yielded good term aesthetic outcomes. Paper IV is a retrospective study of long-term changes in the donor site after harvesting the DIEP flap. Patients were invited to complete BREAST-Q questionnaires regarding the abdomen. The follow-up period was >8 years. Most participants reported no abdominal pain and expressed satisfaction with their abdominal appearance. The outcomes were compared between women with DIEP and women who underwent mastectomy for breast cancer without abdominal-based breast reconstruction. DIEP breast reconstruction did not cause donor site morbidity and women with DIEP reconstruction were more likely satisfied with their abdominal appearance. Briefly, DIEP flap breast reconstruction yields long-lasting favorable outcomes for women undergoing mastectomy