Breast reconstruction using DIEP flap: The free flap alone be enough? Quality of life and satisfaction analysis after complementary surgeries.

Introduction: Breast reconstruction using Deep Inferior Epigastric Perforator (DIEP) flap involves complementary surgeries such as lipofilling, symmetrization, and nipple-areolar complex (NAC) reconstruction. Their role and impact have not been explored yet after the DIEP flap use.

Material And Methods: A retrospective study was performed to evaluate the impact of complementary surgeries on the quality of life of 75 patients after DIEP flap breast reconstruction between 2012 and 2021, comparing the BREAST-Q© score of two groups, patients with DIEP flap only reconstruction and patients with DIEP flap and additional surgeries. Satisfaction for each surgery was assessed using a numeric visual scale on five dimensions (esthetic, self-image, confidence in society, pain, and intimate relationship). Complications and healthcare pathways were also recorded.

Results: Psychosocial well-being (Q1 BREAST-Q©), satisfaction with medical team (Q9) and with surgeon (Q11) was superior in group 2 (p = 0041, p = 0.001 and p = 0.001 respectively). NAC reconstruction improved BREAST-Q© (p = 0029) by regression analysis and was deemed indispensable by 64% of the patients. An important satisfaction is observed after each surgery (DIEP flap, symmetrization, lipofilling and NAC reconstruction). Complications were uncommon (0-4%) for lipofilling and NAC reconstruction and notable but harmless for symmetrization (wound dressings more than a month in 17%).

Conclusion: Complementary surgeries, especially NAC reconstruction, improved BREAST-Q© score, and have a major impact on satisfaction with minor complications. These surgeries should always be proposed to the patients to assess a satisfactory breast reconstruction using DIEP flap.