Impact of Previous Abdominal Surgery on Postoperative Complication of Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Retrospective Comparative Study.

[BACKGROUND] The deep inferior epigastric perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction. Many patients have had previous abdominal surgery (PAS), which poses a challenge in flap harvesting and may impact both abdominal vascularity and structural integrity. This study aimed to clarify the impact of PAS on DIEP flap complications.

[METHODS] A monocentric retrospective analysis of patients undergoing DIEP flap breast reconstruction from February 2018 to May 2024 was conducted. Preoperative characteristics, operative notes, and postoperative complications were collected and analyzed.

[RESULTS] A total of 114 patients, representing 141 DIEP flap breast reconstructions, were included. The study group comprised 58 patients with PAS, whereas the control group included 56 patients without PAS. We observed no significant differences in overall flap or recipient-site ( = 0.365) and abdominal donor-site ( = 0.617) complication rates. A significant increase in overall complication risk was associated with an increase in body mass index ( = 0.041), immediate reconstruction ( = 0.038), and midline laparotomy ( = 0.049) in univariate correlation analysis, and a decrease in flap and recipient-site complications in patients who had a cesarean section ( = 0.035) in multivariate analysis.

[CONCLUSIONS] PAS was not associated with increased complication rates at the flap and recipient-site or abdominal donor site after DIEP flap breast reconstruction. Interestingly, our findings suggest that patients with a history of cesarean section had fewer flap and recipient-site complications.