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Garoosi et al. Plast Aesthet Res 2024;11:42 https://dx.doi.org/10.20517/2347-9264.2024.57 Page 3 of 17

Figure 1. Illustrations of symmetric and asymmetric insetting options for conjoined DIEP stacked flap, extended hemiflap, and separated
stacked DIEP flap. Of note is that the coning illustrated under the extended hemi flap can also be done with conjoined DIEP flaps. DIEP:
Deep inferior epigastric perforator.

Example 1. This is a 17-year-old female with low BMI who underwent left breast reconstruction following dermatofibroma protuberans
resection with a bipedicled/conjoined DIEP free flap to meet both skin deficit and breast volume requirements. Top Left: Preoperative
photo. Note the left upper breast scar from the initial breast mass resection. Top Right: Postoperative photo. Bottom: Intraoperative
photo showing the skin and volume deficit following a recent mastectomy with skin resection to obtain negative margins. BMI: body
mass index; DIEP: deep inferior epigastric perforator.