title: Conservative mastectomies and Immediate-DElayed AutoLogous (IDEAL) breast reconstruction: the DIEP flap.
abstract: BACKGROUND
  With the development of conservative mastectomies, there are an increasing number of women seeking immediate implant based and autologous breast reconstruction. Despite the oncologic safety of the procedures, the focus will be on the timing of reconstruction.
  
  
  METHODS
  Our plastic surgery unit is focused primarily on autologous breast reconstruction and is part of an interdisciplinary breast center. We offer immediate breast reconstruction (IBR) with autologous tissue for patients with positive BRCA 1 and 2, ductal carcinoma in situ (DCIS), invasive cancer without margin problems to the skin, as well as to correct poor oncologic and aesthetic breast conserving therapy (BCT) outcomes. In the majority of cases we prefer an Immediate-DElayed AutoLogous (IDEAL) breast reconstruction concept with a two-stage procedure.
  
  
  RESULTS
  Over the last 10 years we performed more than 1,600 breast reconstructions with free flaps, performing the deep inferior epigastric perforator (DIEP) flap as our first choice for autologous tissue. We recommend IDEAL breast reconstruction, however approximately 15% of our cases are immediate one stage conservative mastectomies and breast reconstruction with the DIEP flap.
  
  
  CONCLUSIONS
  For immediate reconstruction, the aesthetic outcome should not take precedence over oncologic considerations. Immediate one-stage, breast reconstruction with autologous tissue can be offered to the suitable patients which is most likely a healthy women with a small-to-medium sized non ptotic breast receiving a conservative mastectomy. In all other cases, we recommend an IDEAL breast reconstruction approach in order to achieve a final result that is both satisfyingly pleasing and oncologically safe.
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Maximilian
authors: M
authors: Otte
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Carolin
authors: C
authors: Nestle-Krämling
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Sonia
authors: S
authors: Fertsch
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Mazen
authors: M
authors: Hagouan
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Beatrix
authors: B
authors: Munder
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Philip
authors: P
authors: Richrath
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Peter
authors: P
authors: Stambera
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Alina
authors: A
authors: Abu-Ghazaleh
authors: 1 Department of Plastic and Aesthetic Surgery, 2 Department of Senology, Sana Kliniken Düsseldorf, Düsseldorf, Germany.
authors: Christoph
authors: C
authors: Andree
keywords: Mastectomy; deep inferior epigastric perforator flap (DIEP flap); immediate-delayed reconstruction; oncoplastic surgery