title: Breast Reconstruction with Delayed Fat-Graft-Augmented DIEP Flap in Patients with Insufficient Donor-Site Volume.
abstract: BACKGROUND
  Microvascular reconstruction provides natural, lasting breasts that can be integrated easily into body image but most thin patients are often not ideal candidates because of inadequate donor-site volume. The purpose of this study was to present our experience in delayed augmented DIEP flaps with large fat-volume transfer.
  
  
  METHODS
  From 2010 to 2014, 20 consecutive patients were prospectively enrolled for delayed fat-graft-augmented DIEP flaps (active group, AG) and matched with a control group (CG) submitted to the same procedure without fat-injection. Patient's age, mastectomy and flap weight, number of take-backs to the theater for secondary procedures, total treatment period (TTP), and complications were collected and analyzed. Patient and surgeon surveys rated aesthetic outcomes. Continuous and categorical variables were analyzed using student t test and Kruskal-Wallis test, respectively. A value of p ≤ 0.05 was considered statistically significant.
  
  
  RESULTS
  The groups did not differ in age and mastectomy weight (p > 0.05). The AG had a smaller BMI and flap weight (p < 0.05). Comparison of the mean number of take-backs (1.5 in AG vs. 1.4 in CG) and mean TTP (8.6 months in AG vs. 8.9 months in CG) did not show a significant difference (p > 0.05) between groups. Volume, upper/lower-pole shapes, projection, breast mound placement, IMF, symmetry, overall appearance, and general satisfaction sub-items obtained high-score evaluation without a significant difference between groups (p > 0.05).
  
  
  CONCLUSIONS
  Delayed fat-graft-augmented DIEP flaps can be offered to patients with insufficient donor-site volume and medium/large breasts. In comparison with the same technique without fat grafting, no additional take-backs and no prolonged TTP were required to achieve pleasing aesthetic results.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors: Plastic Surgery Department, School of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors: Rosaria
authors: R
authors: Laporta
authors: Benedetto
authors: B
authors: Longo
authors: Michail
authors: M
authors: Sorotos
authors: Marco
authors: M
authors: Pagnoni
authors: Fabio
authors: F
authors: Santanelli di Pompeo
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D016022:Case-Control Studies; D019074:Epigastric Arteries / Q000637:transplantation*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009929:Organ Size; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D060053:Transplant Donor Site / Q000503:physiopathology*; D014182:Transplantation, Autologous; D016896:Treatment Outcome