Introduction: Breast reconstruction is an integral component of comprehensive breast cancer care. The gold standard procedure for autologous, lifelong breast reconstruction is the deep inferior epigastric artery perforator flap (DIEP flap). The DIEP flap is a complex procedure with innumerable critical yet subtle steps in achieving success with some historical drawbacks like prolonged operative time, increased morbidity, pain, longer hospital stay and longer convalescence for the patient. With improved theoretical knowledge, good practical application and improved technology, outcomes are improving significantly.

Aim and Objectives: To evaluate the incidence of complications and patient satisfaction post primary breast reconstruction with DIEP flap.

Materials and Method: We conducted a prospective, non-randomised, feasibility study at a single institute- Manipal hospitals, old airport road, Bangalore. Eligible patients were women aged older than 18 years with a laboratory diagnosis of primary breast cancer requiring mastectomy and post-mastectomy radiotherapy, who were suitable for DIEP flap reconstruction.

Results: The study was conducted from January 2020 to august 2022 which included 21 patients who were eligible for the DIEP flap reconstruction and were followed for 2 years. Out of 21 patients, 4 flaps were turbocharged whereas 10 flaps were super-drained primarily. The average operative time for the whole procedure by adopting a two-team approach is 5.5 hours. Considering aesthetic outcome score, 94.1% had acceptable result (excellent and good). Amongst 21 patients, 2 patient developed mastectomy flap necrosis, 1 had fat necrosis which was managed conservatively whereas 1 had donor site re-exploration for hematoma. There were no incidence of DIEP flap necrosis, seroma, flap site hematoma or flap failure. When breast Q scores were calculated, physical wellbeing module indicated and average of 83 points, psychosocial wellbeing module indicated 80 points whereas sexual scores reverted an average of 77 points. Amongst satisfaction module, aesthetic outcomes for breast showed an average of 94 points whereas the donor site had 96 points. Satisfaction with the information, surgeon, medical staff and other staff came quite satisfactory, each having more than 87 points.

Conclusion: Primary autologous breast reconstruction with DIEP flap yields good aesthetic outcomes and provides the patient a good quality of life. The incidence of fat necrosis, flap and donor site complications are decreasing over time and will enhance the patient satisfaction score further.