Chemotherapy and microsurgical-related vascular complications in DIEP Flap Breast Reconstruction: A Retrospective Study

Purpose To evaluate the association between preoperative chemotherapy and microsurgical vascular complications in patients undergoing Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction, and whether chemotherapy timing affects risk. Methods A retrospective cohort study was conducted at the Department of Plastic and Breast Surgery, Aarhus University Hospital, including all patients who underwent DIEP flap breast reconstructions from January 2020 to October 2024. Reconstructions were grouped as exposed to preoperative chemotherapy (any chemotherapy before reconstruction) and compared to no preoperative chemotherapy (none or >90 days postoperatively). Predefined patient and tumor characteristics, intervention details, chemotherapy exposure, and microsurgical vascular complications were extracted from medical records and analyzed using univariate and multivariate logistic regression. Results In total, 278 DIEP flap breast reconstructions were included. Preoperative chemotherapy was administered in 160 (57.6%) reconstructions, with a median interval of 641 days before reconstruction (IQR 410-924 days), while 118 (42.4%) reconstructions were performed without preoperative chemotherapy. No differences in the odds of vascular complications, including reanastomosis, haematoma, flap loss, composite vascular outcome, infection, or minor complications were observed between groups, in either univariate or multivariate analyses. The interval between chemotherapy and surgery was not associated with vascular complications. Conclusion In this cohort, where most reconstructions were performed long after chemotherapy exposure, preoperative chemotherapy and time from chemotherapy to DIEP flap breast reconstruction were not associated with microsurgery-related vascular complications. These findings support the safety of reconstruction in this setting. Larger multicenter studies are warranted to validate the role of chemotherapy timing and specific regimens.