Dual plane diep flap inset: Optimizing esthetic outcome in delayed autologous breast reconstruction. Issue 6 (28th July 2015)

• Record Type: Journal Article
• Authors: Gravvanis, Andreas; Samouris, George; Galani, Eleni; Tsoutsos, Dimosthenis
• Is Part Of: Microsurgery. Volume 35:Issue 6(2015)
• Page Start: 432
• Page End: 440
• Publication Date: 2015-07-28
• Subjects: Microsurgery -- Periodicals; 617.05
• DOI: 10.1002/micr.22458
• Languages: English
• ISSNs: 0738-1085

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="micr22458-sec-0001" sec-type="section"> <title>Purpose</title> <p>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.</p> </sec> <sec id="micr22458-sec-0002" sec-type="section"> <title>Patients and methods</title> <p>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 (<italic>n</italic> = 25) the flap was inset using the traditional single plane in front of the pectoral muscle. In group‐B (<italic>n</italic> = 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.</p> <p>Photographic images were formulated to a PowerPoint presentation and cosmetic outcomes were assessed by means of a questionnaire and a visual analog scale.</p> </sec> <sec id="micr22458-sec-0003" sec-type="section"> <title>Results</title> <p>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, <italic>P <</italic> 0.05), better transition from native and reconstructed tissues (90.2 ± 1.5 vs. 81.5.6 ± 1.6, <italic>P <</italic> 0.05), better outline of the breast (96.3 ± 1.2 vs. 69.6 ± 2.1, <italic>P<</italic>0.0001), and better overal breast appearance (86 ± 1.5 vs. 72.2 ± 1.9, <italic>P <</italic> 0.0001). Moreover, patient self‐evaluation showed that dual plane reconstruction was associated with higher patient satisfaction without wearing brassiere (<italic>P</italic> = 0.0016), and this could be attributed to the significantly greater fullness of the upper pole (<italic>P</italic> = 0.0015) and significantly less ptosis with time (<italic>P</italic> = 0.0014).</p> </sec> <sec id="micr22458-sec-0004" sec-type="section"> <title>Conclusion</title> <p>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. © 2015 Wiley Periodicals, Inc. Microsurgery 35:432–440, 2015.</p> </sec> </abstract>