Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 14;11(6):e5064.
doi: 10.1097/GOX.0000000000005064. eCollection 2023 Jun.

Postoperative Day 1 Discharge in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Marion W Tapp  1 , Mary L Duet  1 , Thomas N Steele  1 , Robert J Gallagher  2 , Samuel Kogan  1 , Bennett W Calder  1 , J Michael Robinson  3
Affiliations

Postoperative Day 1 Discharge in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Marion W Tapp et al. Plast Reconstr Surg Glob Open. .

Abstract

With high success rates of autologous breast reconstruction, the focus has shifted from flap survival to improved patient outcomes. Historically, a criticism of autologous breast reconstruction has been the length of hospital stay. Our institution has progressively shortened the length of stay after deep inferior epigastric artery perforator (DIEP) flap reconstruction and began discharging select patients on postoperative day 1 (POD1). The purpose of this study was to document our experience with POD1 discharges and to identify preoperative and intraoperative factors that may identify patients as candidates for earlier discharge.

Methods: An institutional review board-approved, retrospective chart review of patients undergoing DIEP flap breast reconstruction from January 2019 to March 2022 at Atrium Health was completed, consisting of 510 patients and 846 DIEP flaps. Patient demographics, medical history, operative course, and postoperative complications were collected.

Results: Twenty-three patients totaling 33 DIEP flaps were discharged on POD1. The POD1 group and the group of all other patients (POD2+) had no difference in age, ASA score, or comorbidities. BMI was significantly lower in the POD1 group (P = 0.039). Overall operative time was significantly lower in the POD1 group, and this remained true when differentiating into unilateral operations (P = 0.023) and bilateral operations (P = 0.01). No major complications occurred in those discharged on POD1.

Conclusions: POD1 discharge after DIEP flap breast reconstruction is safe for select patients. Lower BMI and shorter operative times may be predictive in identifying patients as candidates for earlier discharge.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Predicted location of perforators as aided by preoperative computed tomography angiography.
Fig. 2.
Fig. 2.
Deep inferior epigastric perforator dissection with traditional full length fascial incision. A, DIEP Flap with perforator visualized. B, Abdominal wall. C, Anterior rectus sheath. D, Rectus muscle with large overlying anterior rectus sheath incision. E, Deep inferior epigastric artery and vein with perforator penetrating the DIEP flap.
Fig. 3.
Fig. 3.
Preoperative, intraoperative, and postoperative DIEP flap protocol.
See this image and copyright information in PMC

References

    1. Broyles JM, Balk EM, Adam GP, et al. . Implant-based versus autologous reconstruction after mastectomy for breast cancer: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2022;10:4180. - PMC - PubMed
    1. Jagsi R, Momoh AO, Qi J, et al. . Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst. 2018;110:157–165. - PMC - PubMed
    1. Groth AK, Graf R. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and the textured breast implant crisis. Aesthetic Plast Surg. 2020;44:1–12. - PubMed
    1. Newby JM, Tang S, Faasse K, et al. . understanding breast implant illness. Aesthet Surg J. 2021;41:1367–1379. - PubMed
    1. Martinez CA, Reis SM, Rednam R, et al. . The outpatient DIEP: safety and viability following a modified recovery protocol. Plast Reconstr Surg Glob Open. 2018;6:e1898. - PMC - PubMed