10-Year Experience of Hybrid DIEP with Implant Breast Reconstruction: Univariate Analyses of Risk Factors Associated with Flap Failure.

Background: The combination of deep inferior epigastric artery perforator (DIEP) free flap and implant has been reported as a safe option for breast reconstruction in patients with insufficient abdominal donor tissue. We present a single-surgeon 10-year experience with hybrid reconstruction. Methods: We performed a retrospective review of patients who underwent hybrid breast reconstruction with DIEP and implant by a single surgeon at a single institution between 2014-2024. Patient characteristics and operative factors were analyzed for association with flap failure. Results: 91 patients (153 breasts) were included. Success rate following initial (simultaneous or delayed) implantation and after implant exchange were 98% and 96.1%, respectively. Univariate analyses showed significantly larger mean final implant size in the failed DIEP group (362.50±228.05 mL) compared to the successful reconstruction group (219.20±101.24 mL), with OR of 1.42 (95% CI: 1.149–1.76, p-value = 0.002) per 50 mL increase of the implant size. Conclusions: Hybrid DIEP with implant reconstruction is a safe procedure. Placement of a greater volume implant is associated with flap failure. Implant exchange for upsize also possesses a risk of flap failure.