How to approach the deep inferior epigastric perforator flap revision for optimal aesthetics

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Deep inferior epigastric perforator (DIEP) flap reconstruction has become the gold standard for autologous breast reconstruction, offering favorable outcomes in terms of flap viability and breast aesthetics. However, optimizing both donor and recipient site cosmesis initially and during postoperative revisions remains a critical component of patient satisfaction. This review provides an overview of strategies to enhance aesthetic outcomes in DIEP flap reconstruction, emphasizing donor site contouring, revision timing, and approaches tailored to challenging patient populations. To guide a systematic and intuitive framework for designing the breast, we introduce updated terminology rooted in architectural design: Foundation, Form, and Façade. The initial DIEP flap sets the stage for all subsequent revision surgeries. Preoperatively, key considerations include detailed preoperative assessment and patient expectation management. Intraoperatively, DIEP flap design and inset must be performed with aesthetics in mind. At the donor site, strategic abdominal incision placement and utilization of cosmetic closure techniques are crucial to mimic abdominoplasty results, and methods to preserve or reconstruct the umbilicus for a natural appearance are discussed. Initial postoperative management focuses on modalities to enhance scar healing. Revisions are typically initiated 3-4 months posto

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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