Deep inferior epigastric artery perforator flap breast reconstruction without microsurgery fellowship training

Awareness and provision of reconstruction following mastectomy for breast cancer has increased significantly since the passage of the Women’s Health and Cancer Rights Act in 1998. Subsequently, the number of postmastectomy breast reconstruction cases has also increased, and over 91,000 breast reconstructions were performed by plastic surgeons in the United States in 2012.1,2 Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has been repeatedly shown to result in increased patient satisfaction over implant reconstruction.3,4 However, the ratio of this technique among breast reconstruction cases is exceedingly low, and only 7.1% of all breast reconstructions performed in 2012 were DIEP flap reconstructions.1,2 Because of the complexity and steep learning curve of DIEP flap, most of the plastic surgeons without a formal microsurgical training opt to use simpler methods for breast reconstruction, such as breast implants or pedicled flaps.2,5,6 A recent study has shown that in high-volume breast reconstruction centers, whether or not the plastic surgeon had fellowship training in advanced microsurgical techniques is independently associated with the number of microsurgical reconstructions performed.2 However, the outcomes of DIEP flap breast reconstructions performed by a novice surgeon without microsurgical fellowship training when compared with more experience surgeons have not been studied before. In our Plastic Surgery Division, a series of DIEP flap breast reconstructions were performed by a single full-time academic plastic surgeon, immediately after completion of his plastic surgery residency but without a formal microsurgical fellowship. This study’s goal is to compare complication rates in our series with previously published series in the literature to determine if lack of formal microsurgical fellowship training increases complication rates in DIEP flap breast reconstruction.