Background

• Optimal choice between medial and lateral row perforators for deep

inferior epigastric artery perforator (DIEP) flaps remains contested.

• Medial row associated with lower abdominal wall morbidity

• Lateral row associated with lower rates of fat necrosis.

• These morbidities can take well over a year to declare themselves, and

there are few studies with >12 months follow-up.

Aims

To compare long-term outcomes between DIEP flaps supplied by perforators

from the medial row only, the lateral row only, and from a combination of

both rows.

Methods

• Retrospective review of patients who underwent mastectomy with DIEP

reconstruction between November 2004-December 2021

• > 18 months follow-up

Figure 1. Comparison groups:

• Primary outcomes: fat necrosis, flap loss, hernia, bulge

• Secondary outcomes: 

hematoma, seroma, infection, vascular

complications

 

Results

Demographics

• A total of 226 flaps were included: 172 lateral row, 29 medial

row, and 25 with a combination of both the medial and

lateral rows

• Demographic factors including age, BMI and treatment

history were similar between groups.

 

Surgical Characteristics

• All 3 groups used 3 perforators on average.

• Bilateral reconstruction significantly more common in the

medial row group (Figure 2).

• Mesh use significantly higher in the lateral row group.

 

Post-operative Outcomes

• Clinical fat necrosis was significantly higher in the medial

row group on both univariate and multivariate analysis

(Figure 4 & 5).

• Medial 31%, Lateral 9%, Combo 16% (p=<0.01)

• No significant differences in rate of partial or complete

flap loss between groups.

• No significant difference in rates of hernia or bulge

between groups.

 

Post-Operative Outcomes

• Secondary outcomes including hematoma, seroma, infection and

vascular complications were also similar between groups (Figure 6).

 

• No significant differences in complication rates when looking at the

number of perforators used.

Conclusions

• Medial row perforators yielded higher rate of fat necrosis.

• Perforator selection did not impact abdominal wall morbidity, even when

controlling for potential confounders.

Acknowledgements

Thank you to the breast outcomes database team: Daniel Soroudi, Aileen Gozali, Jasmin Wilson,

Serena Bhaskerrao, Nisha Parmeshwar, Laura Barnes, Catherine Dugan.