Not All Deep Inferior Epigastric Artery Perforator Flaps Are Created Equal: A Review of Donor-site Morbidity in Abdominally Based Autologous Breast Reconstruction.

Background: Breast reconstruction after mastectomy is one of the most common procedures performed in plastic surgery. Autologous reconstruction is associated with better long-term patient satisfaction than implant-based reconstruction but with the requisite donor site and potential for associated morbidity. Methods: The authors review the literature regarding the technical evolution of abdominally based autologous breast reconstruction and the effect of these changes as well as patient morbidities on bulge, hernia, and all-cause donor-site morbidity. Results: The impact of patient risk factors on surgical outcomes is evaluated in the context of constantly improving technical surgical innovation. Patients' premorbid abdominal condition and prior abdominal procedures along with traditional complicating factors such as age, obesity, and smoking are associated with increased rates of donor-site complications. Conversely, shorter fascial incisions with or without robotic and laparoscopic assistance are associated with lower rates of abdominal weakness and healing complications than traditional abdominal free flap harvest. Perforator selection and abdominal closure techniques also play a key role. Conclusions: There are contributions of both patient factors and technical aspects that when optimized can help minimize the risk of donor-site morbidity in deep inferior epigastric artery perforator flap breast reconstruction.