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18-12-2024 | Mastectomy | Original Articles

Enhancing Aesthetics in Bilateral DIEP Flap Breast Reconstruction: the Role of Tissue Pre-Expansion

Authors: Robert Jonathan Musmann, Christoph Andree, Andreas Wolter, Mazen Hagouan, Beatrix Munder, Dirk Janku, Marc Daniels, Kristin Becker, Alan Oramary, Julia Bukowiecki, Annabelle Bromba, Nora Stockhausen, Katrin Seidenstücker, Sonia Fertsch

Published in: Aesthetic Plastic Surgery

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Abstract

Background

Achieving symmetrical outcomes in bilateral autologous breast reconstruction is challenging, particularly in cases of asymmetrical recipient sites. Tissue pre-expansion is proposed to improve aesthetics by enlarging the skin envelope for refined breast shaping. This study examines its efficacy in bilateral DIEP flap reconstructions.

Methods

This study systematically evaluated 43 patients that underwent bilateral DIEP flap breast reconstruction between 2004 and 2021. The efficacy of tissue pre-expansion in enhancing aesthetic outcomes, patient demographics, and complications were analysed. Aesthetic outcomes were measured using the aesthetic item score (AIS).

Results

Patients had an average age of 48.67 years (range: 29–79) and BMI of 27.08 (range: 23–36). Of these, 65.12% had undergone radiotherapy and 83.72% chemotherapy before reconstruction. Patients predominantly received secondary breast reconstruction (72.02%). Pre-expansion significantly improved breast symmetry and the overall aesthetic result (OAR) in cases of asymmetrical recipient-site conditions (3.76 vs. 3.16, p = 0.006 and 7.08 vs. 6.27, p = 0.03, respectively). There was a non-significant trend towards better breast form and volume, with no effect on scarring. For patients with symmetrical recipient-site conditions, pre-expansion did not significantly impact the aesthetic outcome. No significant differences in complication rates were observed.

Conclusion

Tissue pre-expansion significantly enhances aesthetic outcomes of bilateral autologous breast reconstruction, notably breast symmetry and OAR, in patients with asymmetrical recipient-site conditions. However, careful patient selection and preoperative planning are essential for leveraging pre-expansion’s benefits, emphasizing the importance of informed decision-making and expectation management. This publication/study investigates the efficacy of tissue pre-expansion in enhancing aesthetic outcomes for bilateral DIEP flap breast reconstructions. Detailed analysis of 43 patients that received bilateral DIEP reconstruction with and without pre-expansion. Finds significant improvements in breast symmetry and overall aesthetic rating (OAR) for patients with asymmetrical recipient-site conditions.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
Metadata
Title
Enhancing Aesthetics in Bilateral DIEP Flap Breast Reconstruction: the Role of Tissue Pre-Expansion
Authors
Robert Jonathan Musmann
Christoph Andree
Andreas Wolter
Mazen Hagouan
Beatrix Munder
Dirk Janku
Marc Daniels
Kristin Becker
Alan Oramary
Julia Bukowiecki
Annabelle Bromba
Nora Stockhausen
Katrin Seidenstücker
Sonia Fertsch
Publication date
18-12-2024
Publisher
Springer US
Keyword
Mastectomy
Published in
Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-024-04610-0