Page 74 - Read Online

Page 14 of 15 Tang et al. Plast Aesthet Res 2024;11:61 https://dx.doi.org/10.20517/2347-9264.2024.117

transferred except for one patient who had delayed necrosis of the augmentation flap requiring debridement
at two months postoperatively. In addition, we found one case of abdominal donor site infection that was
treated with oral antibiotics, one case of a hematoma on the augmentation side requiring surgical washout,
one case of a hematoma on the reconstructive side that did not require operative intervention, and one
patient with delayed wound healing of bilateral breasts and abdominal donor site. Reports in the literature
on DIEP flaps have indicated an increased risk of abdominal bulge and hernia with the use of lateral row
perforators . Complications relating to post-mastectomy radiation can be detrimental from a
[11]
reconstructive standpoint, causing loss of volume, distortion of the reconstructed breast shape, and
tightening of the skin envelope. Thus, for patients with any possibility of needing post-mastectomy
radiation, we recommend tissue expander placement at the time of mastectomy and pursue reconstruction
in a delayed fashion at least six months following completion of radiation.

SUMMARY WITH SOME KEY POINTS
In select patients undergoing unilateral mastectomy and autologous breast reconstruction who desire
augmentation of the contralateral breast, unilateral breast reconstruction with contralateral augmentation
can be safely and reliably achieved with DIEP flaps. This technique is ideal for patients who desire to avoid
implants and who have adequate lower abdominal tissue.

Preoperative planning with CTA is helpful for mapping out the course of the perforators, calculating the
anticipated volume of the reconstructed and the augmented breast, and designing the anticipated divide
between the larger flap for reconstruction and the smaller flap for augmentation. Perforator selection is
based on the volume needed for each flap, length of pedicle required, location of perforators, and ease of
perforator dissection to minimize abdominal morbidity. Augmentation flaps can be completely buried in
the subangular plane or include a small skin paddle for monitoring which can be excised at a secondary
procedure. Overall, unilateral breast reconstruction with contralateral autologous augmentation is
associated with high levels of patient satisfaction.

DECLARATIONS
Authors’ contributions
Contributed to the writing of the manuscript: Tang SYQ
Contributed to the clinical cases and the writing of the manuscript: Kung TA, Momoh AO

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Approval by the review board is not applicable. Written informed consent for participation was obtained
from all subjects.

Consent for publication
Written informed consent was obtained from patients for publication.