Medial Row Perforators Are Associated With Higher Rates Of Fat Necrosis in Bilateral DIEP Flap Breast Reconstruction.

Background: The purpose of this study is to evaluate perfusion related complications in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction based on perforator selection. Methods: A retrospective review of a prospectively maintained database was performed on all patients undergoing bilateral DIEP flap reconstruction at a single institution between 2004-2014. The hemiflaps were separated into three cohorts based on perforator location: lateral row only, medial row only, and medial plus lateral row. Postoperative flap related complications were compared and analyzed. Results: There were 728 total hemiflaps: 263 (36.1%) based on the lateral row, 225 (30.9%) based on the medial row, and 240 (33.0%) based on both the medial and lateral row. The groups were well matched by perforator number and flap weight. Fat necrosis occurrence was significantly higher in flaps based solely on the medial row versus lateral row perforators (24.5% versus 8.2%, p

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