DIEAP flap selection for unilateral breast reconstruction: a comparison of flap side harvest

Background For breast reconstruction, the deep inferior epigastric artery perforator (DIEAP) flap can be harvested at the same side as that in mastectomy (ipsilateral) or from the contralateral hemi-abdomen. This paper seeks to establish the benefits of either side of DIEAP flap harvest, on the basis of our experience and a literature review. Methods We analysed our experience with the DIEAP flap and compared the two different technical approaches to flap harvesting. Using the internal mammary vessels as the standard recipient, with comparable vessels on either side, we compared the differences between harvesting on the contralateral and ipsilateral hemi-abdomen and analysed any references to it in the literature. Results Seventy-three DIEAP flaps were harvested for breast reconstruction, over a 2-year period, by the two senior authors. Of the 44 cases where the ipsilateral hemi-abdomen was used, this was the routine primary choice of the operating surgeon in 42 cases. The contralateral hemi-abdomen was the preferred choice in 29 cases. We accessed 302 papers related to the topic of breast reconstruction using a DIEAP flap, of which 63 papers were reviewed, based on the abstracts. Only six of these papers mentioned their routine or preferred choice of the hemi-abdomen. Conclusions There appears to be no consensus in the literature as to the preferred side of DIEAP flap harvest, if the perforators are of similar calibre and ease of dissection. Modern DIEAP flap harvest is based on the preoperative selection of the most reliable perforator. In relation to mastectomy defect, this may be on the ipsilateral or contralateral. Level of Evidence: Level IV, prognostic/risk study