A single-operator technique for DIEP flap raise in high-BMI patients

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Surgical Innovation

Background:

• High body mass index (BMI) presents challenges in autologous breast reconstruction using deep inferior epigastric perforator (DIEP) flaps.
• Increased risks include wound healing complications, fat necrosis, and donor-site morbidity.
• Intraoperative technical difficulties during flap harvest in high-BMI patients are underreported.

Purpose of the Study:

• To describe a reproducible, single-operator technique for deep inferior epigastric perforator (DIEP) flap harvest in high BMI patients.
• To address the intraoperative technical challenges associated with managing a heavy abdominal pannus.
• To streamline flap harvest, reduce surgeon strain, and improve operative efficiency.

Main Methods:

• A modified approach involving limited incision and dissection to harvest only necessary flap dimensions.
• Sequential exposure down to fascia with a suspension suture for superior abdominal skin secures.
• Focused identification of the superficial inferior epigastric vein (SIEV) via a longitudinal incision, avoiding wide pannus retraction.

Main Results:

• The technique simplifies pannus management and optimizes exposure, enhancing safety and reproducibility.
• Reduced dependence on experienced assistance and minimized operator strain.
• Streamlined flap harvest, reduced surgeon energy expenditure, and shortened operative times observed in this patient subgroup.

Conclusions:

• This modified DIEP flap harvest technique overcomes challenges in high-BMI patients.
• The approach enhances safety, efficiency, and reproducibility of autologous breast reconstruction.
• Wider access to safe, natural-tissue breast reconstruction for high-BMI patients may be facilitated.