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

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.