AAPS 104th Annual Meeting

Breast Reconstruction with the Buried Deep Inferior Epigastric Perforator Flap Without Postoperative Device Monitoring

Sarah A. Amjad, BS1; Antonio J. Forte, MD, PhD2; Olivia A. Ho, MD2; Adekunle I. Elegbede, MD, PhD2; Brian D. Rinker, MD, FACS2
1Mayo Clinic Alix School of Medicine, Jacksonville, FL, 2Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL

Background

•Flap survival rates exceed 99% in many published series, bringing into question the need for intensive device monitoring of flaps`.

•At our institution we have been performing reconstruction with fully buried DIEP flaps without device monitoring in select cases since 2018.

OBJECTIVE: This study evaluates the safety and outcomes of buried unmonitored DIEP flaps compared to traditional monitoring.

Methods

•Retrospective review of 182 patients undergoing DIEP flap breast reconstruction at Mayo Clinic Florida from 2018-2022.

•Patients were divided into buried and non-buried groups, and demographic/baseline characteristics and outcome measures were collected

•Outcome measures were reoperation, readmission, operative time, follow-up time, reconstructive procedures, and complications.

•Continuous variables were compared using Wilcoxon rank sum test and categorical variables were compared using Chi-squared or Fisher’s exact test.

•Multivariable logistic regression models were used to compare risks for prolonged LOS and OR time between the groups.

•Tests were two-sided with p<0.05 considered significant.

Results

•There were 80 patients in the buried, non-monitored group, and 102 patients in the non-buried group.

•Infectious and wound complications were not different between the groups.

•Overall flap survival was 98.5% and was 100% in the buried group.

•There were more OR takebacks in the non-buried group (10 versus 3).

•Buried flaps demonstrated shorter mean operative times (7.1 vs. 8.4 hours, p<0.0001) and hospitalizations (3.5 vs. 3.9 days, p=0.005).

Discussion

•Recent studies have examined whether an unburied monitoring flap provides measurable benefits in DIEP flap breast reconstruction but have utilized internal monitoring techniques2-4.

•We found that patients with buried, unmonitored DIEP flap breast reconstruction had similar complication rates and fewer readmissions, reoperations, and secondary procedures that those undergoing non-buried flaps.

Conclusion

•These findings support the efficacy and safety of buried DIEP flaps without device monitoring.

• Flap monitoring is unnecessary to get similar, highly positive outcomes in DIEP flap breast reconstruction.

• Additionally, buried DIEP flaps may offer a reduction in peri and postoperative hospital utilization.

References

1.Zhang A, Salingaros S, Wright MA, Black GG, Otterburn DM. Complications After Deep Inferior Epigastric Perforator Flap Breast Reconstruction for Nipple-Sparing Mastectomy: A Series of 380 Flaps. Ann Plast Surg. Apr 1 2025;94(4S Suppl 2):S283–S290. doi:10.1097/SAP.0000000000004252

2.Lignieres A, Andejani DF, Chu CK, Largo RD, Mericli AF. No Skin Paddle, No Problem: Burying Deep Inferior Epigastric Artery Flaps in the Immediate Setting is Safe in Select Patient Populations. J Reconstr Microsurg. Nov 2024;40(9):722–729. doi:10.1055/a-2320-5665

3.Creasy H, Citron I, Davis TP, Cooper L, Din AH, Rose V. Buried Autologous Breast Reconstruction: Outcomes and Technical Considerations. J Clin Med. Mar 2 2024;13(5)doi:10.3390/

4.Rose V, Cooper L, Pafitanis G, Hogben K, Sharma A, Din AH. Single-stage buried autologous breast reconstruction (BABR). J Plast Reconstr Aesthet Surg. Sep 2022;75(9):2960–2969. doi:10.1016/j.bjps.2022.04.033

AAPS 104th Annual Meeting

Breast Reconstruction With The Buried Deep Inferior Epigastric Perforator Flap Without Postoperative Device Monitoring

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