A Breast Reduction Technique for the Free DIEP Flap Post Breast Reconstruction.

Breast flap remodeling is a common procedure after breast reconstruction. We present a unique approach to breast reduction using a superomedial pedicle inverted "T" technique in patients with previous free deep inferior epigastric perforator (DIEP) flap breast reconstruction, not previously reported. Breast reduction can be a valid option for reshaping breasts after free DIEP flap reconstruction.

Imaging in Autologous Breast Reconstruction.

The evolution of imaging actively shapes clinical management in the field. Ultrasonography (US), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) stand out as the most extensively researched imaging modalities for ABR. Ongoing advancements include "real-time" angiography and three-dimensional (3D) surface imaging, and future prospects incorporate augmented or virtual reality (AR/VR) and artificial intelligence (AI).

Accessibility of Neurotization in Deep Inferior Epigastric Perforator Flap Reconstruction: Inequities and Implications for Preauthorization.

Background:  Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated.

Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach.

Transabdominal Robotic Harvest of Bilateral DIEP Pedicles in Breast Reconstruction: Technique and Interdisciplinary Approach.

Background:  The deep inferior epigastric artery perforator (DIEP) flap is the gold standard for autologous breast reconstruction. However, the conventional procedure's anterior sheath division, from perforating vessels to the pedicle origin, risks weakening the abdominal wall's primary strength layer. Employing the da Vinci Xi Surgical System with indocyanine green dye and near-infrared fluorescence imaging, we refined a robotic technique for bilateral DIEP flap harvest.

NIRO200NX: Reliable Monitoring System for Buried Deep Inferior Epigastric Perforator Flap.

Background: The deep inferior epigastric perforator (DIEP) flap is a useful tool for breast reconstruction and tends to be transferred into the breast envelope as the buried flap from an aesthetic point of view. However, it is difficult to monitor the blood flow in the buried DIEP flap after reconstructive microsurgery. Near-infrared spectroscopy devices have recently been used for monitoring the blood flow of various organs.

The first 150 consecutive DIEP free flaps: Lessons learnt and a guide to efficiency for the junior plastic surgeon.

Introduction: The deep inferior epigastric artery perforator (DIEP) free flap is the gold-standard for breast reconstruction but is technically demanding, resource intensive and time-consuming, making it a daunting task for the junior surgeon.

Aim: To report the lessons learnt from the experience of a single surgeon performing their first 150 DIEP reconstructions as a guide for junior surgeons.

Methods: Data regarding patient demographics and surgical outcomes from April 2021 to October 2022 were collected retrospectively from medical records.

Early Experience with Mesh Suture for DIEP Flap Abdominal Site Closures.

Background: The gold standard of microsurgical breast reconstruction is the deep inferior epigastric perforator (DIEP) free flap. As techniques have evolved, DIEP flaps have significantly reduced the morbidity previously caused by transverse rectus abdominis muscle (TRAM) and muscle-sparing TRAM flaps. However, abdominal wall complications continue to persist after DIEP flap surgery, with bulge rates reported as high as 33%.

Evaluating the Quality and Impact of TikTok Videos on Autologous Breast Reconstruction with Deep Inferior Epigastric Perforator Artery Flaps.

Background: With the rising influence of social media on healthcare perceptions, this study investigates TikTok's role in educating the public about autologous breast reconstruction, specifically focusing on deep inferior epigastric perforator flaps.

Methods: We conducted a systematic analysis of 152 TikTok videos related to deep inferior epigastric perforator flap procedures, evaluating the accuracy of the content, viewer engagement metrics, and the influence of content creator characteristics on viewer interactions.

Results: Our analysis identified a wide variance in the quality of information, with many videos lacking in-depth educational content, thereby posing a risk of misinformation.

Thigh Perforator Exchange: Intraflap Perforator Augmentation of Anterolateral Thigh Free Flaps.

Peripheral perfusion in large anterolateral thigh flaps may be inadequate if perforator zones are not properly planned during flap design and harvest, and variations in vascular anatomy can contribute to operative difficulty and morbidity. Intraflap anastomosis of extrinsic perforators may allow for augmentation of perfusion while avoiding significant intramuscular dissection. Adaptation of the perforator exchange technique, previously described in autologous breast reconstruction, optimizes vascular flow in anterolateral thigh flaps.

Quality of Video Content Related to Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Social Media Platforms Versus Large Language Models.

Introduction: The deep inferior epigastric perforator (DIEP) flap is currently one of the main options in breast reconstruction. The information about this surgery is critical for the patient, in order to choose the breast reconstruction method. Our study aims to analyze and compare the quality and accuracy of the information related to the DIEP flap reconstruction method provided by social media platforms (SMPs) and the new large language models (LLMs).

Enhanced Recovery After Surgery (ERAS) With Exparel in Tissue Expander-based Breast Reconstruction Following Mastectomy.

Background: Enhanced recovery after surgery (ERAS) pathways have been widely shown to yield positive outcomes, including in plastic surgery. Our group has previously validated ERAS in our deep inferior epigastric perforator flap breast reconstruction population.

Objectives: We evaluated whether the ERAS protocol and addition of liposomal bupivacaine affected patient outcomes at the time of mastectomy and first-stage tissue expander reconstruction.

[Indocyanine green is an integral part of breast reconstructive surgery using perforator flaps].

Introduction: The use of allotransplants for breast reconstruction in surgical stage of the the breast cancer treatment requires tissue perfusion control. The aim of the study was to analyze the effectiveness of using indocyanine green as a drug for determining the perfusion of perforant flaps in breast reconstructive surgery.

Material And Methods: A retrospective series of observations of 27 breast reconstructions using autologous transplants is presented: 19 reconstructions with DIEP-flap, 2 with SIEA-flap, 5 with TD-flap; 1 with thoracoepigastric flap.

Flap-Based Reconstruction in Patients with Autoimmune Disease: An Institutional Experience with the Deep Inferior Epigastric Perforator Flap and Review of the Literature.

Background:  Autoimmune diseases are associated with characteristic chronic inflammation, aberrations in tissue perfusion, and hypercoagulability, and thus have considerable implications for local and free-flap reconstruction. We seek to summarize the current evidence on outcomes of flap-based reconstruction in patients with pre-existing autoimmune disease and present our experience with autologous breast reconstruction in this population.

Methods:  PubMed, Embase, Scopus, Cochrane, and Web of Science were searched for relevant articles, and pertinent data were presented qualitatively.

The impact of physical activity on patient-reported outcomes following deep inferior epigastric perforator flap breast reconstruction.

Introduction: Although higher preoperative physical activity levels have been shown to be beneficial to postoperative recovery at large, their effect on patient-reported outcomes after deep inferior epigastric perforator (DIEP) flap breast reconstruction has yet to be investigated. This study aimed to correlate patient physical activity levels with patient-reported outcome measures.

Methods: A prospectively maintained database of patients who underwent DIEP flap breast reconstruction between July 2021 and June 2022 was analysed.

Anomalous anatomic variation of an absent deep inferior epigastric artery: implications for autologous breast reconstruction.

Autologous breast reconstruction using abdominally based perforator flaps has become increasingly popular following mastectomy for breast cancer. Of these, the deep inferior epigastric artery perforator (DIEP) flap represents one of the most popular techniques. However, surgeons must remain cognizant of anatomic variations in the abdominal wall vasculature that could complicate or preclude planned DIEP flaps.

A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps.

Background:  Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps.

Perfusion area versus volume of the DIEP flap: A multivariable analysis of perforator and flap characteristics for estimation of perfusion area and volume.

Background: The extent of perfusion of a deep inferior epigastric artery perforator (DIEP) flap is a primary concern for surgeons. This study aimed to determine whether the flap area or volume can be estimated using perforator and flap characteristics.

Methods: Intraoperative flap perfusion was assessed using indocyanine green angiography in patients who underwent DIEP flap breast reconstruction between November 2018 and February 2023.

Effectiveness of the proximal medial branch in DIEP flaps for breast reconstruction using Hartrampf zone IV.

Background: When performing breast reconstruction using a deep inferior epigastric artery (DIEA) perforator (DIEP) flap, including Hartrampf zone IV, the bipedicled DIEP flap has been argued to be necessary to ensure stable perfusion. However, a proximal medial branch (PMB), which is the most proximal perforator of DIEA, may make it possible to obtain adequate perfusion in a unilateral DIEP flap. This study aimed to clarify the detailed anatomical characteristics of PMB and its potential clinical applications in breast reconstruction.

Utility of 3D-printed vascular modeling in microsurgical breast reconstruction: a systematic review.

Background: Microsurgical breast reconstruction presents a technical challenge in preoperative planning and flap harvest. Given the limitations of computed tomographic angiography as a preoperative aid, 3D printing has emerged as an avenue for creating patient-specific anatomical models for pre- and intraoperative use. This systematic review assesses the current use and utility of 3D-printed vascular models (3DVMs) in microsurgical breast reconstruction.

Short-term versus extended chemoprophylaxis against venous thromboembolism in DIEP flap breast reconstruction: A retrospective study of 424 patients.

Background: Autologous breast reconstruction is considered high-risk for deep vein thrombosis (DVT) and thromboembolism (PE). It is therefore recommended to treat patients undergoing these complex and lengthy procedures with DVT chemoprophylaxis. The optimal anticoagulation protocol is still not established.

A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression.

Background:  This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.

Methods:  A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria.