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Updated: Feb 5, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Secondary breast reconstruction after mastectomy using the DIEP flap
T Hauck1, R E Horch1, M Schmitz1
1Department of Plastic and Hand Surgery, University Hospital of Erlangen, Erlangen, Germany; Interdisciplinary Breast Center, University Hospital of Erlangen, Erlangen, Germany.
Autologous breast reconstruction using deep inferior epigastric perforator (DIEP) or muscle-sparing transverse rectus abdominis musculocutaneous (MS-TRAM) flaps is a safe and reliable technique. These microsurgical methods offer low flap loss rates, enhancing breast cancer therapy outcomes.
Area of Science:
- Plastic Surgery
- Oncology
- Microsurgery
Background:
- Autologous microvascular breast reconstruction is crucial for successful breast cancer therapy.
- Deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) TRAM flaps are considered gold standards.
- This study highlights technical aspects of DIEP flap reconstruction based on extensive experience.
Purpose of the Study:
- To present technical aspects of free microsurgical autologous breast reconstruction using DIEP flaps.
- To analyze outcomes of DIEP and MS-TRAM flaps in a large patient cohort.
Main Methods:
- Retrospective analysis of 137 patients undergoing autologous microsurgical free flap breast reconstruction between 2013 and 2017.
- DIEP flap used in 33 patients; MS-TRAM flap used in 104 patients.
- Demonstration of operative steps for DIEP flap reconstruction.
Main Results:
- Overall total flap loss rate was 2.2%; partial flap necrosis occurred in less than 1%.
- 61% of patients had prior irradiation, with no observed correlation to flap loss.
- The study involved patients aged 32-78 years (mean 52).
Conclusions:
- Autologous breast reconstruction with DIEP or MS-TRAM flaps is a surgically safe procedure.
- Specialized centers achieve low flap loss rates with these techniques.
- These methods are reliable reconstructive options for breast cancer patients.
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