D25. Assessment Of Anatomic Eligibility for Robotic-assisted Diep Flap Harvest

PURPOSE: The traditional open approach to deep inferior epigastric perforator (DIEP) flap harvest risks abdominal wall weakness due to a large fascial incision. The recently introduced robotic-assisted DIEP flap harvest technique (R-DIEP) addresses this risk by minimizing the fascial incision. Patients are currently thought to be eligible for this technique if there is a large perforator with a short intramuscular course (IC). This study aims to assess what proportion of patients are anatomically eligible for R-DIEP. METHODS: Retrospective review was conducted of patients undergoing DIEP flap breast reconstruction from 2019-2023. Pre-operative magnetic resonance angiography identified the largest perforator at or below the umbilicus on each hemi-abdomen. The intramuscular course length was measured by calculating the hypotenuse of a prism formed by entry and exit points through the rectus abdominis muscle. Eligibility for R-DIEP was defined using conservative (<2.5 cm) and liberal (<5 cm) IC thresholds. RESULTS: Among 579 dominant perforators in 295 patients, average IC was 3.7 ± 1.5 cm (range: 0-11.0 cm). Twenty-nine percent (n=167) of perforators had <2.5cm IC, and 77% (n=446) had <5 cm IC. Forty-six percent of patients (n=135) had at least one dominant perforator with <2.5cm IC, and 93% of patients (n=278) had at least one dominant perforator with <5cm IC. CONCLUSION: Even at this early point in its development, a significant proportion of patients are suitable for R-DIEP, especially when considering liberal criteria. As surgeons become more facile with the technique, an even higher proportion of patients will likely be deemed anatomically eligible.