Fat Grafting for Deep Inferior Epigastric Perforator Flap Refinements in Breast Reconstruction: The Hybrid Autologous Reconstruction

Abstract

Breast reconstruction performed using deep inferior epigastric perforator flap (DIEP) is currently applied in reconstructive microsurgery and can be considered the gold standard of autologous breast reconstruction. Nowadays it is important to focus on the aesthetic outcome recreating symmetrical natural-appearing breasts while preserving patient safety and quality of life. Clinical experience has shown that poor abdomen shape and partial marginal liponecrosis of the flap may follow large perforator flaps. Additional lipofilling procedures may be necessary to improve aesthetic outcomes of the reconstructed breast or abdominal donor site. In selected patients the abdomen is not the only source of fat that can be transferred to reconstruct the breast. In those patients we developed a two-stage procedure consisting in a first step with moderate-sized DIEP flap and a second one with fat injection harvested from different body areas. Usually one lipofilling injection was enough because of the high rate of fat intake in the highly vascularized new breast tissue. The authors call this procedure the Hybrid Autologous breast reconstruction.