Clinical outcome of abdominal wall after DIEP flap harvesting and immediate application of abdominoplasty techniques.
BACKGROUND
Although breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is a well-known technique, few publications have reported the aesthetic outcome of the abdomen and the donor-site closure techniques utilized. The aim of this study was to analyze the feasibility of immediate clinical application of traditional abdominoplasty techniques after DIEP flap harvesting.


METHODS
Forty-four patients underwent 48 DIEP flap breast reconstructions, with 32 immediate and four bilateral procedures. All patients underwent full abdominoplasties with some technique of musculoaponeurotic system plication. Information on age, weight, height, smoking status, comorbid medical conditions, complications, and revision surgery was collected.


RESULTS
In all patients, the anterior rectus fascia was closed by a two-layer imbrication-type closure and the rectus diastasis was corrected by a median plicature. In 36 patients (81.8 percent), a contralateral rectus plicature was performed. In 21 patients (47.7 percent), plication of the external oblique aponeurosis was performed. All patients achieved an improved abdominal contour, and 41 (93.2 percent) were satisfied with their result. Ten patients (22.7 percent) had minor complications.


CONCLUSIONS
Clinical application of abdominoplasty techniques is feasible immediately after DIEP harvesting and must address not only skin and subcutaneous tissue but also the muscular abdominal wall. All of the musculofascial plication techniques improved the definition of the waistline. Patient selection is crucial to achieve a satisfactory outcome. The main objective is that patients safely undergo dual procedures with no increased risk and with the added aesthetic benefits at the abdominal donor site.
Munhoz
Alexandre Mendonça
AM
Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
Sturtz
Gustavo
G
Montag
Eduardo
E
Arruda
Eduardo Gustavo
EG
Aldrighi
Cláudia
C
Gemperli
Rolf
R
Ferreira
Marcus Castro
MC
D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000071938:Fasciotomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome