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Breast. 2016 Apr;26:59-66. doi: 10.1016/j.breast.2015.12.005. Epub 2016 Jan 27.

DIEAP flap for safe definitive autologous breast reconstruction.

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Department for Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf, Gräulingerstr. 120, Düsseldorf, DE 40625, Germany.
Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
Department of Plastic and Reconstructive Surgery, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, United Kingdom. Electronic address:



Breast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.


1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.


Overall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).


The DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.


Autologous breast reconstruction; Breast reconstruction; DIEAP flap breast reconstruction; Free flap breast reconstruction

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