Epigastric hernia following DIEP flap breast reconstruction: complication or coincidence?

OBJECTIVE Donor site hernias are a rare but well recognised complication of deep inferior epigastric perforator (DIEP) flap breast reconstruction but there are no reported cases of epigastric hernias after such surgery. We report three patients who developed symptomatic epigastric hernias within 2-8 months after discharge from follow-up. PATIENTS AND METHODS Patients who were referred to the Breast Plastic Surgery Clinic with symptomatic epigastric hernias following DIEP flap breast reconstruction were retrospectively reviewed. RESULTS The three patients were aged between 50 and 70 years. Their mean BMI was 29 and none were smokers or diabetic. The incidences of other predisposing factors were: previous abdominal surgery (1/3), heavy lifting (2/3) and multiparity (2/3). They were successfully treated laparoscopically (2) or by open technique (1) confirming the CT scan findings. DISCUSSION AND CONCLUSION The aetiology of epigastric hernias is obscure in general. The association with DIEP flap harvest may be purely coincidental. However, it appears that abdominal flap harvest predisposed these patients to epigastric hernias. One or more of the following factors may have caused either weakness of the anterior abdominal wall or increased intraabdominal pressure: * Short-term partial denervation of the rectus abdominis muscle; * Heavy lifting; * Previous surgery; obesity; multiple pregnancies; * Tight plication of the infraumbilical rectus sheath and muscle. This series of 3 symptomatic epigastric hernias following DIEP flap breast reconstruction is interesting as it documents donor site morbidity at a site distant from the exact site of flap harvest; this subject merits further detailed investigation.