Summary
Objective
Donor site hernias are a rare but well recognised complication of deep inferior epigastric
perforator (DIEP) flap breast reconstruction but there are no reported cases of epigastric
hernias after such surgery. We report three patients who developed symptomatic epigastric
hernias within 2–8 months after discharge from follow-up.
Patients and methods
Patients who were referred to the Breast Plastic Surgery Clinic with symptomatic epigastric
hernias following DIEP flap breast reconstruction were retrospectively reviewed.
Results
The three patients were aged between 50 and 70 years. Their mean BMI was 29 and none
were smokers or diabetic. The incidences of other predisposing factors were: previous
abdominal surgery (1/3), heavy lifting (2/3) and multiparity (2/3). They were successfully
treated laparoscopically (2) or by open technique (1) confirming the CT scan findings.
Discussion and conclusion
The aetiology of epigastric hernias is obscure in general. The association with DIEP
flap harvest may be purely coincidental. However, it appears that abdominal flap harvest
predisposed these patients to epigastric hernias. One or more of the following factors
may have caused either weakness of the anterior abdominal wall or increased intraabdominal
pressure:
- •Short-term partial denervation of the rectus abdominis muscle
- •Heavy lifting
- •Previous surgery; obesity; multiple pregnancies
- •Tight plication of the infraumbilical rectus sheath and muscle
This series of 3 symptomatic epigastric hernias following DIEP flap breast reconstruction
is interesting as it documents donor site morbidity at a site distant from the exact
site of flap harvest; this subject merits further detailed investigation.
Keywords
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References
- The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.Br J Plast Surg. 1997; 50: 322-330
- A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.Plast Reconstr Surg. 2004; 113: 1153-1160
- Epigastric hernia and its etiology.Hernia. 2002; 6: 148-150
- Primary and unusual abdominal wall hernias.Surg Clin North Am. 2008; 88 (viii): 45-60
- Surgical anatomy of the aponeurotic expansions of the anterior abdominal wall.Ann R Coll Surg Engl. 1977; 59: 313-321
- DIEP flaps in women with abdominal scars: are complication rates affected?.Plast Reconstr Surg. 2008; 121: 1527-1531
- Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery.Br J Plast Surg. 1994; 47: 495-501
- Electromyographic assessment of rectus abdominis muscle function after deep inferior epigastric perforator flap surgery.Plast Reconstr Surg. 2004; 113: 156-161
- The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps.Br J Plast Surg. 2002; 55: 35-45
Article info
Publication history
Published online: August 02, 2011
Accepted:
July 9,
2011
Received:
June 2,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
