Stepwise Assessment and Full Evaluation in DIEP flap after abdominal liposuction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Abdominal liposuction history complicates Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction due to potential perforator vessel damage.
• Concerns exist regarding compromised perforator vessels and superficial venous systems from liposuction-induced scarring or cannula injury.

Purpose of the Study:

• To develop a decision-making algorithm for autologous breast reconstruction using DIEP flaps in patients with prior abdominal liposuction.
• To evaluate the safety and efficacy of the SAFE-DIEP protocol in this patient cohort.

Main Methods:

• Retrospective, monocentric observational clinical study (2011-2024) of female patients over 18 undergoing DIEP flap reconstruction post-liposuction.
• Preoperative assessment included abdominal angio-CT and color Doppler ultrasound.
• Intraoperative evaluation utilized clinical assessment and indocyanine green fluorescence angiography.

Main Results:

• Deep Inferior Epigastric Perforator (DIEP) flap reconstructions were successful despite challenges from prior abdominal liposuction.
• The SAFE-DIEP protocol, assessing both arterial and venous systems, effectively mitigated complications.
• No flap failures or significant complications were reported in the study cohort.

Conclusions:

• Autologous breast reconstruction with DIEP flaps is achievable in patients with a history of abdominal liposuction.
• Thorough preoperative planning and intraoperative assessments, guided by the SAFE-DIEP protocol, are crucial for success.
• This approach minimizes risks and ensures favorable outcomes in challenging cases.