title: Subcutaneous pre-expansion of mastectomy flaps before breast reconstruction with deep inferior epigastric perforator flaps: eliminating the patch-like appearance and improving aesthetic outcomes.
abstract: BACKGROUND
  Free tissue transfer and tissue expansion are important tools in the reconstructive surgeon's armamentarium, yet are not often used in conjunction. Although tissue transfer has its advantages, the patch-like appearance of the skin paddle on the breast can be unappealing.
  
  
  OBJECTIVE
  To present our clinical experience of using subcutaneous breast tissue expansion before reconstruction with deep inferior epigastric perforator (DIEP) flaps, and to show how this technique eliminates the patch-like appearance of the skin paddle.
  
  
  METHODS
  Five patients underwent delayed breast reconstruction using a 3-stage approach. During the first stage, tissue expanders were placed in the subcutaneous plane beneath the mastectomy flaps. After complete tissue expansion, the second stage involved removal of the tissue expanders and reconstruction of the breasts by burying deepithelialized DIEP flaps beneath the pre-expanded skin flaps. Revisions and nipple reconstructions were carried out in the third stage. Retrospective analysis of patients' characteristics, breast history, surgical stay, complications, and outcomes were performed.
  
  
  RESULTS
  The patients were, on average, 49 years of age, with an average body mass index of 26.3. One patient underwent bilateral breast reconstruction whereas the rest had unilateral reconstructions. Two patients had minor complications. There were no DIEP failures or take-backs.
  
  
  CONCLUSIONS
  Using subcutaneous breast tissue expansion followed by DIEP flap reconstruction can be performed safely, offering patients a completely autologous breast reconstruction with low morbidity, as well as eliminating the classical patch-like appearance of flap reconstructions.
authors.affiliation: Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada.
authors.forename: Karl
authors.initials: K
authors.lastname: Schwarz
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
mesh_terms: D000328:Adult; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011300:Preoperative Care; D013524:Surgical Flaps; D015626:Tissue Expansion