[Delayed breast reconstruction using DIEP flap without skin paddle: Technique, evaluation and management]

The deep inferior epigastric perforator (DIEP) flap has emerged as a gold standard in delayed breast reconstruction (DBR). Although the skin paddle technique is often employed to restore both volume and the skin envelope simultaneously. This procedure presents an aesthetic drawback, commonly referred to as a "patch" effect. We propose a three-stage approach to avoid this issue: initial reconstruction with a prosthesis combined with an abdominal advancement flap and contralateral breast symmetrization, followed by conversion to a buried DIEP flap with an option for further refinement. The objective of our study is to evaluate the security et efficiency of this method.

A monocentric, and retrospective study was conducted, encompassing patients who began this protocol between July 2019 and December 2023. Complications and their management were documented at each stage.

A total of eighty-two procedures were initiated. In the first stage, sixteen patients (19.5%) experienced complications resembling prosthesis rejection, such as skin inflammation or seroma, most of which required surgical intervention coupled with antibiotic therapy. Seventy-two patients (87.8%) proceeded to DIEP flap reconstruction with complete burial of the flap, with an average of 1.39 touch-ups per patient. Five patients (6.09%) were satisfied with their prosthetic reconstruction and opted not to convert.

The strategy of DBR using a DIEP flap with complete burial, offers a reliable and aesthetically alternative to skin paddle reconstruction. This study underscores the safety and reproducibility of the technique, along with effective management of complications.