From My Houston Surgeons.
Plast Reconstr Surg. 2023 Feb 1;151(2):234e-240e. doi: 10.1097/PRS.0000000000009836. Epub 2022 Nov 11.
The authors describe the use of deep inferior epigastric perforator (DIEP) flaps in outpatient cosmetic breast augmentation.
The authors reviewed patients who had undergone cosmetic breast augmentation with DIEP flaps over a 12-month period. Any patient who desired breast augmentation, implant exchange, or augmentation mastopexy with concomitant abdominoplasty was considered a candidate for the procedure. All patients underwent an early recovery protocol including microfascial incisions to harvest the DIEP flaps and rib preservation in addition to early recovery after surgery protocols with intraoperative anesthetic blocks.
Eleven consecutive patients underwent bilateral cosmetic breast augmentation with DIEP flaps and mastopexy. Overall, all patients reported preoperative dissatisfaction with their abdomen and breasts. Microfascial incisions for single perforator abdominal flaps ( n = 17) averaged 1.7 cm (range, 1.3 to 2.4 cm) and flaps with multiple perforators ( n = 5) averaged 2.4 cm (range, 2 to 2.5 cm). Dissection of recipient internal mammary artery vessels was performed without disruption of the rib. No fascia or muscle tissue was taken during flap dissection. All patients had strong Doppler signals before discharge within 23 hours. No partial or total flap losses, major complications, or take-backs were reported.
Patients who desire abdominoplasty and augmentation are ideal candidates for this procedure. Breast augmentation with autologous tissue, particularly the DIEP flap, is an attractive option inherent to the additional abdominal tissue available to harvest. The early recovery protocol allows the surgeon to perform microsurgical breast reconstructions and augmentations in an outpatient setting, with excellent results and no total or partial flap losses, offsetting the high costs associated with the DIEP flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
作者描述了在门诊美容乳房增大中使用深部下腹壁穿支皮瓣（DIEP）的情况。
作者回顾了在 12 个月期间接受 DIEP 皮瓣美容乳房增大的患者。任何希望进行乳房增大、植入物更换或伴有腹侧整形术的增大乳房悬吊术的患者都被认为是该手术的候选者。所有患者均接受早期恢复方案，包括用于采集 DIEP 皮瓣的微创筋膜切口以及肋骨保存，以及手术中麻醉块的术后早期恢复方案。
11 例连续患者行双侧美容乳房增大伴乳房悬吊术。总体而言，所有患者均报告术前对腹部和乳房不满意。用于单个穿支腹部皮瓣（n=17）的微创筋膜切口平均为 1.7 厘米（范围，1.3 至 2.4 厘米），具有多个穿支的皮瓣（n=5）平均为 2.4 厘米（范围，2 至 2.5 厘米）。在不破坏肋骨的情况下进行受体内乳动脉血管的解剖。在皮瓣解剖过程中不使用筋膜或肌肉组织。所有患者在 23 小时内出院前均具有强烈的多普勒信号。没有部分或全部皮瓣丢失、重大并发症或再次手术的报告。
渴望进行腹侧整形术和增大术的患者是该手术的理想人选。使用自体组织（特别是 DIEP 皮瓣）进行乳房增大是一种诱人的选择，因为可以从可用的额外腹部组织中收获。早期恢复方案使外科医生能够在门诊环境中进行显微乳房重建和增大，具有出色的效果，并且没有全部或部分皮瓣丢失，减轻了与 DIEP 皮瓣相关的高昂费用。
临床问题/证据水平：治疗性，IV 级。
