246 Optimising Perforation Selection: Impact of Perforator Number on DIEP Flap Breast Reconstruction

Abstract Aim Perforator selection is critical in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Single-perforator harvest simplifies dissection but may increase fat necrosis risk, multiple perforators improve perfusion at the cost of complexity. This study aims to optimize outcomes by investigating the impact of perforator number and patient-specific factors on fat necrosis. Method A retrospective analysis of prospectively maintained data was conducted for 335 patients who underwent unilateral DIEP flap breast reconstruction between January 2016 and December 2023. Patient demographics, comorbidities, intraoperative parameters, and postoperative outcomes were examined. Statistical tests included Fisher’s exact test for categorical variables, Wilcoxon rank-sum test for continuous variables, and multivariate logistic regression to identify predictors of fat necrosis. Results Of 335 DIEP flaps, 127 used a single perforator, while 208 used multiple perforators. Fat necrosis occurred in 11% of single-perforator flaps (n=14) and 3% of multi-perforator flaps (n=7). Univariate analysis revealed a significantly higher risk of fat necrosis in single-perforator flaps (OR 1.7, 95% CI [1.2–2.5], p = 0.01). Multivariate regression confirmed this association after adjusting for confounders. Smoking and morbid obesity were also significant independent predictors. Conclusions Fewer perforators significantly increase the risk of fat necrosis in DIEP flap breast reconstruction. Patient factors, including smoking and morbid obesity, are independent predictors. These findings underscore the importance of optimizing perforator selection to minimize complications.