A randomized clinical trial comparing breast and abdominal related morbidity of DIEP and SIEA flaps

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Peters, Blair
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Background: The deep inferior epigastric perforator flap (DIEP) is the current standard of care in autologous breast reconstruction. The newer superficial inferior epigastric artery flap (SIEA) is felt to be an improvement as it does not damage the abdominal wall. The SIEA flap unfortunately is reported to have smaller vessels which put the flap at higher risk of developing flap loss and fat necrosis. The uncertainty regarding the tradeoffs inherent in the choice of procedure has not been resolved by the current literature. As such we have aimed to perform a randomized single blinded trial to evaluate the abdominal and breast related morbidty associated with DIEP and SIEA flaps. Methods: A blinded, randomized, prospective cohort study is being performed involving Manitoban women over 18 years undergoing unilateral or bilateral breast reconstruction. Women are randomized to either receive the DIEP or SIEA flap procedure. Objective isokinetic abdominal muscle and back extensor strength testing is being done preoperatively and 3, 6 and 12 months post-operatively. A validated abdominal wall and breast outcome questionnaire (Breast-Q) is being administered pre-operatively and at 3 and 12 months post. Secondary outcomes measured include: fat necrosis, flap loss, abdominal wound breakdown, seroma rate and length of hospital stay. Statistical analyses include a combination of parametric and non-parametric tests. Results: Preliminary analyses have shown some post-operative decreases in the DIEP abdominal assessments. Some of the complication rates appear to be higher in the SIEA group, however sample sizes are currently too small for the differences to be called significant. At this point there does not appear to be an significant difference in the intra-operative findings between groups. Conclusions: Although the data in this report is preliminary we believe that upon completion of this study, we will go further than others in controlling variability and providing pure data for analysis. By examining outcomes on both donor site morbidity and breast flap complications, we hope to clearly delineate the benefits and tradeoffs inherent in the choice of procedure.