Long-term follow-up after DIEP flap breast reconstruction: Quality of life with a focus on donor-site morbidity

Background: The DIEP flap is widely used for breast reconstruction post-mastectomy, known for its superior aesthetic results. Given the variety of reconstruction options available, evaluation of donor site satisfaction is essential for informed patient counseling and decision-making. This study assesses the overall quality of life and long-term patient satisfaction with the abdominal donor site after DIEP flap breast reconstruction. Methods: This retrospective cross-sectional study at Maastricht University Medical Center identified patients who underwent DIEP flap breast reconstruction over the past 15 years. Data mining tools searched electronic medical records for relevant procedures. Eligible participants received an online questionnaire using validated Dutch translations of the BREAST-Q and BODY-Q to measure satisfaction and physical well-being of the abdomen. Statistical analyses were performed using SPSS 29.0, employing multiple linear regression to investigate associations between demographic and clinical variables and satisfaction scores. Results: A total of 563 questionnaires were initiated, and 470 patients were included for further analysis. The mean age at surgery was 51.5 years, with a mean BMI of 26.8. Patients reported high aesthetic satisfaction but experienced functional discomfort. Significant correlations were found between BMI, age, comorbidities (diabetes, hypertension), and satisfaction scores. Conclusion: This study on DIEP flap breast reconstruction highlights high aesthetic satisfaction despite functional discomfort, with satisfaction decreasing as BMI increases. It underscores the importance of pre-operative weight management, individualized patient counseling, and consideration of age and comorbidities to optimize post-surgical satisfaction. The unexpected positive correlations between diabetes, hypertension, and satisfaction scores warrant further investigation.