Morelli Coppola Marco, Schaffer Clara, Jaber Giulio Jad, Sapino Gianluca, di Summa Pietro Giovanni
Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Aesthetic Plast Surg. 2025 Apr;49(7):1959-1962. doi: 10.1007/s00266-024-04502-3. Epub 2024 Dec 2.
In microvascular breast reconstruction, the focus has shifted to achieving aesthetically pleasing results. Delayed breast reconstruction poses challenges such as ensuring natural ptosis and avoiding a "patch" effect. The Be.A.U.T-I.F.U.L. deep inferior epigastric perforator (DIEP) flap inset, presented here, offers a systematic and sequential seven-step method to optimize breast reconstruction outcomes.
This approach emphasizes safety during flap harvest using the best (Be.) perforator identified via computed tomography angiography to minimize dissection and ensure solid perfusion. The flap is placed obliquely, directing its tail to the axilla (A.), enhancing upper (U.) pole volume and ptosis. The flap base is tucked-in (T-I.) to increase the projection of the breast mound, and its lateral portion is split as a fishtail (F.): the upper (U.) fin is used to define the lateral inframammary fold and prevent lateral displacement of the reconstructed breast, while the lower (L.) fin is turned under the flap to further improve projection.
This structured approach, focusing on key breast aesthetics, ensures optimal cosmetic outcomes and can serve for most delayed microsurgical breast reconstruction scenarios.
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在微血管乳房重建中，重点已转向实现美观的效果。延迟乳房重建带来了诸多挑战，比如要确保自然下垂并避免“补丁”效应。本文介绍的Be.A.U.T - I.F.U.L.腹壁下深动脉穿支（DIEP）皮瓣植入法提供了一种系统的七步法，可优化乳房重建效果。
该方法强调在皮瓣切取过程中的安全性，使用通过计算机断层血管造影确定的最佳（Be.）穿支，以尽量减少解剖操作并确保充足的灌注。皮瓣倾斜放置，将其尾部指向腋窝（A.），增加上（U.）极的体积和下垂度。将皮瓣基部内折（T - I.）以增加乳房隆起的突出度，其外侧部分像鱼尾一样劈开（F.）：上（U.）鳍用于确定乳房下皱襞外侧并防止重建乳房的外侧移位，而下（L.）鳍翻转到皮瓣下方以进一步改善突出度。
这种注重关键乳房美学的结构化方法可确保达到最佳的美容效果，适用于大多数延迟性显微外科乳房重建情况。
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