Venous thromboembolism prophylaxis regimen for patients undergoing deep inferior epigastric perforator flap breast reconstruction

Background: Patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction are at increased risk for venous thromboembolism (VTE) due to prolonged operative times, cancer-associated hypercoagulability, and postoperative immobility. Despite this risk, consensus is limited regarding standardized prophylaxis regimens for this population. We assessed VTE incidence in patients undergoing DIEP flap breast reconstruction after implementing a standardized, multimodal VTE prophylaxis regimen. Methods: We retrospectively reviewed patients who underwent DIEP flap breast reconstruction at our institution between October 2021 and July 2024. Patients were subjected to a standardized VTE prophylaxis regimen including preoperative education and subcutaneous heparin injection, intraoperative efficiency techniques, and a postoperative protocol consisting of early ambulation, sequential compression devices, compressive garments, and a 2-week course of enoxaparin sodium. Patient characteristics, operative details, and VTE outcomes were analyzed. Results: In a cohort of 110 patients, 187 DIEP flap reconstruction procedures were performed by one surgeon. Mean patient age was 49.3 years, and mean body mass index was 29.7. The VTE rate directly attributable to DIEP flap reconstruction was 0%. One VTE event occurred-an upper extremity deep vein thrombosis (DVT) 119 days postoperatively that was associated with intravenous access during a revision procedure. No lower-extremity DVTs or pulmonary embolisms were reported. Conclusions: Implementation of a standardized, comprehensive VTE prophylaxis regimen encompassing preoperative, intraoperative, and postoperative measures can result in a remarkably low VTE rate in patients undergoing DIEP flap breast reconstruction. This safe, effective regimen may eliminate the need for risk-based pharmacologic stratification tools such as the Caprini model.