title: Aesthetic refinements and reoperative procedures following 370 consecutive DIEP and SIEA flap breast reconstructions: important considerations for patient consent.
abstract: BACKGROUND
  Breast reconstruction often requires multiple operations. In addition to potential complications requiring reoperation, additional procedures are frequently essential in order to complete the reconstructive process, with aesthetic outcome and breast symmetry shown to be the most important factors in patient satisfaction. Despite the importance of these reoperations in decision-making and the consent process, a thorough review of the need for such operations has not been definitively explored.
  
  
  METHODS
  A review of 370 consecutive autologous breast reconstructions (326 patients) was undertaken, comprising 365 deep inferior epigastric artery perforator (DIEP) flaps and 5 superficial inferior epigastric artery (SIEA) flaps. The need for additional procedures for either complications or aesthetic refinement following initial breast reconstruction was assessed.
  
  
  RESULTS
  Overall, there was an average of 1.06 additional interventions for every patient carried out after primary reconstructive surgery. Of 326 patients, 46 underwent early postoperative operations for surgical complications (0.17 additional operations per patient as a consequence of complications). Procedures for aesthetic refinement included those performed on the reconstructed breast, contralateral breast, or abdominal donor site. Procedures for aesthetic refinement included nipple reconstruction, nipple-areola complex tattooing, dog-ear correction, liposuction, lipofilling, scar revision, mastopexy, and reduction mammaplasty.
  
  
  CONCLUSIONS
  While DIEP flap surgery for breast reconstruction provides favorable results, patients frequently require additional procedures to improve aesthetic outcomes. The need for reoperation is an important part of the consent process prior to reconstructive surgery, and patients should recognize the likelihood of at least one additional procedure following initial reconstruction.
authors.affiliation: Department of Plastic Surgery, Uppsala University Hospital, 75185, Uppsala, Sweden. m.enajat@live.nl
authors.forename: Morteza
authors.initials: M
authors.lastname: Enajat
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Smit
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Ed H M
authors.initials: EH
authors.lastname: Hartman
authors.forename: Anders
authors.initials: A
authors.lastname: Liss
authors.forename: Morten
authors.initials: M
authors.lastname: Kildal
authors.forename: Thorir
authors.initials: T
authors.lastname: Audolfsson
authors.forename: Rafael
authors.initials: R
authors.lastname: Acosta
mesh_terms: D000328:Adult; D000368:Aged; D004954:Esthetics; D005260:Female; D006801:Humans; D007258:Informed Consent; D016462:Mammaplasty; D008875:Middle Aged; D012086:Reoperation; D013524:Surgical Flaps; D055815:Young Adult