Dual plane diep flap inset: Optimizing esthetic outcome in delayed autologous breast reconstruction

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Abstract
Purpose: In the present study, we compare the esthetic outcome in delayed autologous breast reconstruction, in the spectrum of irradiated chest wall, following two different abdominal flap inset.Patients and methods: Fifty women, candidates for microsurgical reconstruction with a free deep inferior epigastric perforator (DIEP) flap, participated in this prospective, randomized control study. In group‐A (n = 25) the flap was inset using the traditional single plane in front of the pectoral muscle. In group‐B (n = 25) the flap was inset in a dual plane lying simultaneously behind and in front of the pectoralis major at the upper and lower poles of the reconstructed breast, respectively.Photographic images were formulated to a PowerPoint presentation and cosmetic outcomes were assessed by means of a questionnaire and a visual analog scale.Results: The dual plane flap inset presented significant advantages over the traditional single plane because of a better scarring (85.6 ± 1.3 vs.73.6 ± 1.2, P < 0.05), better transition from native and reconstructed tissues (90.2 ± 1.5 vs. 81.5.6 ± 1.6, P < 0.05), better outline of the breast (96.3 ± 1.2 vs. 69.6 ± 2.1, P<0.0001), and better overal breast appearance (86 ± 1.5 vs. 72.2 ± 1.9, P < 0.0001). Moreover, patient self‐evaluation showed that dual plane reconstruction was associated with higher patient satisfaction without wearing brassiere (P = 0.0016), and this could be attributed to the significantly greater fullness of the upper pole (P = 0.0015) and significantly less ptosis with time (P = 0.0014).Conclusion: The dual plane DIEP flap inset improves scar quality, advances the breast shape and fullness of the upper pole, and results in higher patient satisfaction. © 2015 Wiley Periodicals, Inc. Microsurgery 35:432–440, 2015.

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