title: Dual plane diep flap inset: Optimizing esthetic outcome in delayed autologous breast reconstruction.
abstract: OBJECTIVE
  In the present study, we compare the esthetic outcome in delayed autologous breast reconstruction, in the spectrum of irradiated chest wall, following two different abdominal flap inset.
  
  
  METHODS
  Fifty women, candidates for microsurgical reconstruction with a free deep inferior epigastric perforator (DIEP) flap, participated in this prospective, randomized control study. In group-A (n = 25) the flap was inset using the traditional single plane in front of the pectoral muscle. In group-B (n = 25) the flap was inset in a dual plane lying simultaneously behind and in front of the pectoralis major at the upper and lower poles of the reconstructed breast, respectively. Photographic images were formulated to a PowerPoint presentation and cosmetic outcomes were assessed by means of a questionnaire and a visual analog scale.
  
  
  RESULTS
  The dual plane flap inset presented significant advantages over the traditional single plane because of a better scarring (85.6 ± 1.3 vs.73.6 ± 1.2, P < 0.05), better transition from native and reconstructed tissues (90.2 ± 1.5 vs. 81.5.6 ± 1.6, P < 0.05), better outline of the breast (96.3 ± 1.2 vs. 69.6 ± 2.1, P<0.0001), and better overal breast appearance (86 ± 1.5 vs. 72.2 ± 1.9, P < 0.0001). Moreover, patient self-evaluation showed that dual plane reconstruction was associated with higher patient satisfaction without wearing brassiere (P = 0.0016), and this could be attributed to the significantly greater fullness of the upper pole (P = 0.0015) and significantly less ptosis with time (P = 0.0014).
  
  
  CONCLUSIONS
  The dual plane DIEP flap inset improves scar quality, advances the breast shape and fullness of the upper pole, and results in higher patient satisfaction.
authors.affiliation: Department of Plastic Surgery-Microsurgery and Burn Center J. Ioannovich, General Hospital of Athens G.Gennimatas, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gravvanis
authors.affiliation: Department of Plastic Surgery-Microsurgery and Burn Center J. Ioannovich, General Hospital of Athens G.Gennimatas, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Samouris
authors.affiliation: Department of Plastic Surgery-Microsurgery and Burn Center J. Ioannovich, General Hospital of Athens G.Gennimatas, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Galani
authors.affiliation: Department of Plastic Surgery-Microsurgery and Burn Center J. Ioannovich, General Hospital of Athens G.Gennimatas, Athens, Greece.
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Tsoutsos
mesh_terms: D000328:Adult; D019074:Epigastric Arteries / Q000601:surgery; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D061525:Perforator Flap / Q000098:blood supply; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors