Dual plane diep flap inset: Optimizing esthetic outcome in delayed autologous breast reconstruction

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.

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 (n = 25) the flap was inset using the traditional single plane in front of the pectoral muscle. In group-B (n = 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. Photographic images were formulated to a PowerPoint presentation and cosmetic outcomes were assessed by means of a questionnaire and a visual analog scale.

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, P < 0.05), better transition from native and reconstructed tissues (90.2 ± 1.5 vs. 81.5.6 ± 1.6, P < 0.05), better outline of the breast (96.3 ± 1.2 vs. 69.6 ± 2.1, P<0.0001), and better overal breast appearance (86 ± 1.5 vs. 72.2 ± 1.9, P < 0.0001). Moreover, patient self-evaluation showed that dual plane reconstruction was associated with higher patient satisfaction without wearing brassiere (P = 0.0016), and this could be attributed to the significantly greater fullness of the upper pole (P = 0.0015) and significantly less ptosis with time (P = 0.0014).

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.