Prepectoral Implant Placement with Pedicle Division and Resorbable Mesh Reinforcement for DIEP Flap Augmentation

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Microsurgery

Background:

• Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction is a common microsurgical technique.
• Hybrid breast reconstruction combines autologous tissue with implants for augmentation.
• Prepectoral augmentation offers potential advantages over subpectoral placement.

Purpose of the Study:

• To evaluate the safety and efficacy of delayed prepectoral Deep Inferior Epigastric Perforator (DIEP) augmentation.
• To assess outcomes in both primary DIEP augmentation and revision settings (prepectoral conversion).

Main Methods:

• Retrospective review of patient records from August 2018 to August 2024.
• Analysis of abdominally-based free flaps performed by a single surgeon.
• Specific focus on cases undergoing delayed prepectoral DIEP augmentation.

Main Results:

• 585 abdominally-based free flaps were performed; 32 (5.5%) underwent prepectoral DIEP augmentation.
• No acute flap complications related to implant placement occurred.
• Two cases of implant inferior malposition were noted, resolved by adopting TIGR matrix support.

Conclusions:

• Delayed prepectoral DIEP augmentation is a safe and effective hybrid breast reconstruction technique.
• Consideration of inferior soft tissue support is crucial, particularly with smooth implants.