Cosmetic Microsurgery: Outpatient Autologous Breast Augmentation with DIEP flaps
Sameer Shakir, MD, Tom Paliga, MD, Suhail K. Kanchwala, MD
University of Pennsylvania, Philadelphia, PA
Background: Each year thousands of patients undergo augmentation mastopexy and abdominoplasty colloquially known as a “mommy-makeover”. There are many patients who desire augmentation but are fearful of the long term maintenance and complications of breast implants. Given advances in microsurgical technique, enhanced recovery, and surgical efficiency we elected to perform microsurgical breast augmentation using the patient’s own abdominoplasty specimen in a series of three patients.
Methods: We selected three patients who had undergone significant weight loss who desired abdominoplasty and presented the concept of microsurgical autologous breast augmentation. A meticulous informed consent was obtained and the patient was seen multiple times prior to surgery. The patient was informed that if there were any complications from the flap dissection the procedure would be aborted and implants would be used. Similarly, we discussed that postoperative complications would be handled by flap explant and implant placement.
Results: Two patients obtained CT angiography and one patient was imaged with handheld Doppler ultrasound. All flaps were single perforator DIEP flaps harvested with a limited fascial incision. The average fascial incision length was 3.7cm (2.1-5.3cm). Average flap size was 285cc (243-365). Total length of surgery was 4.7hours (4.5-5.3hrs). Patients spent an average of 5 hours in the recovery room before being discharged to home. There were no flap related complications in this small series. All flaps remained soft and viable at an average of 9 months followup. The average cost for OR and Anesthesia was $3700 (surgeons fees were waived).
Conclusion: We present a series of 3 outpatient autologous breast augmentation cases performed with DIEP flaps. For some patients this may present an alternative to implant use and represents the ideal marriage of reconstructive and aesthetic techniques. In the past, surgical time and prolonged hospital stay have made such procedures cost prohibitive. While our results are certainly encouraging, further study is needed to refine technique and patient.
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