PHILADELPHIA (June 6, 2025) — New research by a Fox Chase Cancer Center physician shows that DIEP flap surgery is extremely safe, with a low rate of readmission and complications.
The findings support making deep inferior epigastric perforator (DIEP) flap surgery, which uses fat and tissue from the lower abdomen to rebuild one or both breasts, more widely available to patients undergoing reconstruction after mastectomy, said senior author Sameer Patel, MD, FACS, Chief of Plastic and Reconstructive Surgery at Fox Chase. They also provide more evidence to support offering reimbursement for the procedure from insurers.
“We have been able to show that the outcomes are very good and that readmission and complication rates are low. We have also demonstrated that this is an option that really should be offered to patients as a standard, effective way to achieve breast reconstruction,” Patel said. However, breast implants remain the most common type of reconstruction offered to patients and covered by insurance, he noted.
The DIEP flap procedure involves a longer and more complex initial surgery that requires specialized training for the surgeon, but it also offers significant advantages over implants. Notably, breast implants require ongoing monitoring using either ultrasound or MRI imaging, and the implants themselves must be replaced every 10 to 20 years.
“That can be burdensome, especially for younger patients — they’re looking at multiple exchanges during their lifetime and screening throughout,” Patel said. “DIEP flap doesn’t require any of that, and it also gives you a more natural appearing result.”
In spite of these advantages, DIEP flap surgery is often not offered to patients because it is considered too complex or risky. Recently, some insurance providers have moved to reduce reimbursements for the procedure.
Researchers at Fox chase, which is one of the few cancer centers in the region to offer DIEP flap reconstruction, wanted to take a closer look at the procedure’s safety. For the new study, they analyzed data from more than 32,000 patients who underwent DIEP flap surgery nationwide, the largest set of data studied for this procedure.
Key findings included a reoperation rate of 7%, slightly higher than previously reported. Researchers also found a 2% rate of infection requiring readmission, the first time this finding has been reported. Other complications like wound dehiscence, where a wound ruptures along a surgical incision, and thromboembolic events occurred at rates less than 1%.
One surprising finding was the most common reason for readmissions, noted lead author Heather Peluso, DO, a plastic and reconstructive surgeon at Mid-Atlantic Permanente Group, Largo Medical Center, and previously a plastic and reconstructive surgery fellow at the Lewis Katz School of Medicine at Temple University, a fellowship program headed by Patel.
“It’s not because of issues related to flap survival, or thromboembolic issues, it’s actually infection that seems to be driving readmission,” she said. She noted that, even with this finding, both infection and readmission rates are quite low.
“The big picture here is that this is a safe operation that does not add a lot of cost to the health system,” Patel said. “If you compare readmission and infection rates to implants, those numbers are either equivalent or higher than what we are showing for DIEP flap.”
Follow up studies will take a closer look at causes and outcomes of reoperation after DIEP flap surgery, he added.
The paper, “Outcomes of 32,019 Deep Inferior Epigastric Perforator Flap Reconstructions: Insights From the Largest National Readmission Data,” was published in Plastic and Reconstructive Surgery Global Open.