title: Delayed Mammoplasty with Silicone Gel Implants following DIEP Flap Breast Reconstruction.
abstract: The deep inferior epigastric artery perforator (DIEP) flap is a state-of-the-art option for breast reconstruction. However, thin patients with medium- to large-size native breasts are not ideal candidates due to the limited amount of available tissue. We reviewed our experience utilizing the DIEP flap in combination with prosthetic implants.
  
  
  METHODS
  We conducted a retrospective chart review of 7 patients, totaling 11 implants, who underwent breast reconstruction with the DIEP flap and subsequent mammoplasty. All cases underwent previous mastectomies. No implant placement was offered at the time of their DIEP flap reconstruction. Immediate breast reconstruction with the DIEP flap was performed in 9 cases, whereas 2 required delayed reconstruction secondary to postmastectomy radiotherapy. No patients received postreconstruction radiotherapy. Breast asymmetry and inadequate volume were the primary indications for mammoplasty. For all cases, we used smooth, round silicone gel implants, which were placed in the subpectoral region.
  
  
  RESULTS
  Mean age was 43 years. One patient was actively smoking. Four patients underwent bilateral implant placement. The mean time of delay between breast reconstruction and mammoplasty was 61 weeks. Average volume of silicone implants was 229 mL. A medial pedicle vertical mastopexy was performed in 1 patient on a nonreconstructed breast to achieve symmetry. Five patients underwent nipple reconstruction. All patients underwent delayed mammoplasty without intraoperative complications and good aesthetic results.
  
  
  CONCLUSIONS
  Delayed mammoplasty following DIEP flap breast reconstruction is a safe and feasible procedure for patients who seek an aesthetic and natural-looking breast but lack adequate abdominal tissue.
authors.affiliation: Department of Surgery, The University of Texas School of Medicine, Houston, Tex.; Houston Plastic & Craniofacial Surgery, Houston, Tex.
authors.forename: Jules A
authors.initials: JA
authors.lastname: Walters
authors.affiliation: Department of Surgery, The University of Texas School of Medicine, Houston, Tex.; Houston Plastic & Craniofacial Surgery, Houston, Tex.
authors.forename: Erika A
authors.initials: EA
authors.lastname: Sato
authors.affiliation: Department of Surgery, The University of Texas School of Medicine, Houston, Tex.; Houston Plastic & Craniofacial Surgery, Houston, Tex.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Martinez
authors.affiliation: Department of Surgery, The University of Texas School of Medicine, Houston, Tex.; Houston Plastic & Craniofacial Surgery, Houston, Tex.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Hall
authors.affiliation: Department of Surgery, The University of Texas School of Medicine, Houston, Tex.; Houston Plastic & Craniofacial Surgery, Houston, Tex.
authors.forename: Sean G
authors.initials: SG
authors.lastname: Boutros