Bilateral breast reconstruction with a two-stage DIEP flap: A single-center experience.

[BACKGROUND] The deep inferior epigastric perforator flap (DIEP) is the gold standard for autologous breast reconstruction (ABR), but its viability can be challenged in resource-reduced environments like Mexico, where bilateral DIEP reconstructions are rare due to their complexity. A two-stage procedure has been introduced to improve flap viability and mitigate surgeon-related factors.

[OBJECTIVE] This study is to describe the two-stage technique to improve flap survival in bilateral DIEP flap reconstructions and to report the results in a center with limited hours and resources.

[METHODS] A retrospective case series included women aged≥18years who underwent two-stage bilateral DIEP flap procedures, either immediately or delayed, from January 2021 to July 2024. Key variables assessed included flap success rates, demographics, risk factors, complications, and surgical times.

[RESULTS] Twenty breasts were reconstructed in 10 patients. The mean age was 49.5years, 4 were smokers, 3 had prior abdominal surgeries, and 7 had received radiotherapy. The first-stage surgery averaged 145.5minutes, with a 4.3-day interval before the second stage, which lasted 243minutes. The overall flap success was 100%, with one case of partial flap loss, which did not compromise the final outcome. Complications included wound dehiscence (10%) and venous congestion (5%). The average hospital stay was 9.6days.

[CONCLUSIONS] The two-stage DIEP flap technique is a viable option for high-risk patients, yielding satisfactory outcomes and reducing complications. This method addresses surgeon-related challenges, enhancing overall results. Further research on flap delay in free flaps is recommended for improved practices in difficult settings.