Outcomes of Unmonitored, Buried DIEP Flaps in Autologous Breast Reconstruction

BACKGROUND: DIEP flap survival rates are between 97-99% in autologous breast reconstruction, which questions the need for device monitoring of flaps. Despite this, no studies have investigated whether fully buried DIEP flaps for breast reconstruction without device monitoring are equally efficacious. We sought to further investigate whether buried DIEP flaps without device monitoring were associated with similar complication rates to the traditional monitoring paddle. METHODS: A retrospective cohort review of 182 consecutive patients undergoing DIEP flap breast reconstruction performed at our institution between January 2018 to December 2024. Outcome measures were reoperation, readmission, operative time, follow-up time, reconstructive procedures, and complications. Continuous variables were compared using Wilcoxon rank sum test and categorical variables were compared using Chi-squared test or Fisher’s exact test. Multivariable logistic regression models were used to compare risks for prolonged LOS and OR time between buried and non-buried groups. The tests were two-sided with p-value <0.05 considered statistically significant. RESULTS: There were 80 patients in the buried, non-monitored group, and 102 patients in the non-buried group. Overall flap survival was 100% and 98.5% in the buried and non-buried groups, respectively. There were more OR takebacks in the non-buried group (10 versus 3). Infectious and wound complications were not different between the groups. Buried flaps demonstrated shorter mean operative times (7.1 vs. 8.4 hours, p<0.0001) and hospitalizations (3.5 vs. 3.9 days, p=0.005). CONCLUSIONS: These findings support the efficacy and safety of buried DIEP flaps without device monitoring, while providing potential benefits in operative efficiency and postoperative recovery.