title: Clinical outcome of abdominal wall after DIEP flap harvesting and immediate application of abdominoplasty techniques.
abstract: 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.
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.forename: Gustavo
authors.initials: G
authors.lastname: Sturtz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.forename: Eduardo Gustavo
authors.initials: EG
authors.lastname: Arruda
authors.forename: Cláudia
authors.initials: C
authors.lastname: Aldrighi
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: 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