Comparing Plastic Surgeon Operative Time for DIEP Flap Breast Reconstruction

2-Stage More Efficient Than 1-Stage?

Christopher J. Issa, BSc; Stephen M. Lu, MD, MDiv; Elizabeth M. Boudiab, MD; Jeffrey DeSano, DO; Neil S. Sachanandani, MD; Jeremy M. Powers, MD; Kongkrit Chaiyasate, MD


Plast Reconstr Surg Glob Open. 2021;9(6):e3608 

In This Article


We found that reconstruction over 2 procedures resulted in a significant reduction in total OR time for the plastic surgeon for both unilateral and bilateral reconstruction, without significantly prolonging total patient time under anesthesia for unilateral reconstruction. Future studies are required to track anesthetic-related complications and long-term outcomes.

Through the findings of this study, patients desiring autologous reconstruction may be informed that placing an initial expander and delaying flap reconstruction allows for the preservation of skin envelope and completion of adjuvant therapies, and only significantly prolonging time under anesthesia by about 99 minutes in bilateral reconstruction. With amenable breast surgeons and patients, the advantages of controlling scheduling and the operating room may encourage plastic surgeons to consider performing free flap reconstruction in a delayed fashion.