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Indications and Outcomes of Autologous Conversion from Implant-Based Breast Reconstruction.
In this study, we explored the transition from implant-based to autologous breast reconstruction, focusing on the factors prompting conversion, patient outcomes, and the role of emerging flap types such as profunda artery perforator (PAP) a…
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Using Social Media to Understand Patient Perceptions of Deep Inferior Epigastric Perforator Flap Reconstruction.
[BACKGROUND] The deep inferior epigastric perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction due to its muscle-preserving technique and favorable outcomes compared with the transverse rectus abdomini…
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Microsurgical Breast Reconstruction Options After Abdominoplasty: Lumbar Artery Perforator Versus Profunda Artery Perforator.
[BACKGROUND] Patients who have undergone abdominoplasty face limited options for microsurgical breast reconstruction, as the deep inferior epigastric perforator flap is often unavailable. This study compared lumbar artery perforator (LAP) a…
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Reduction in Seroma Rate Following Deep Inferior Epigastric Perforator Flap with Umbilectomy Utilizing Progressive Tension Sutures.
[BACKGROUND] Umbilectomy has been implemented in both abdominoplasties and deep inferior epigastric perforator (DIEP) flaps to improve abdominal wound healing and better control the location of the neoumbilicus; however, seroma rates are i…
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To Ablate or Not to Ablate: Does Umbilectomy Decrease Donor-Site Complications in DIEP Flap Breast Reconstruction?
[BACKGROUND] Improving outcomes for deep inferior epigastric perforator (DIEP) flap breast reconstruction is an evolving area of interest. The aim of this study was to evaluate the effect of umbilectomy in abdominally based breast reconstru…
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How to Start a Microsurgery Practice: Success and Sustainability in Academic Practice.
Starting an academic microsurgery practice is a daunting task for plastic surgery graduates. Despite this, academic practice provides many advantages as a starting point for a career. Microsurgical faculty can make use of several unique ben…
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Operative Time Predicts Long-Term Abdominal Morbidity and Complication Requiring Treatment after DIEP Flap Breast Reconstruction.
[BACKGROUND] The relationship between skin-to-skin operative time and long-term complications, as well as complications requiring treatment, after deep inferior epigastric perforator (DIEP) flap breast reconstructions has not been thorough…
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Bilateral Simultaneous Lumbar Artery Perforator Flaps in Breast Reconstruction: Perioperative Outcomes Addressing Safety and Feasibility.
[BACKGROUND] The lumbar artery perforator (LAP) flap has emerged as an excellent option for breast reconstruction, but its steep learning curve makes it less approachable. Furthermore, length of the operation, flap ischemia time, need for c…
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Aesthetic Evaluation and Validation: Umbilicus Reconstruction after DIEP Flap.
[BACKGROUND] The most common method for autologous breast reconstruction is the deep inferior epigastric perforator (DIEP) flap. The umbilicus can be managed in various ways, including re-inset, neoumbilicus, and umbilectomy without recons…
- Comparative outcomes in breast reconstruction: autologous techniques and long-term functionality.
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Multi-Flap Microsurgical Autologous Breast Reconstruction.
Microsurgical autologous breast reconstruction (MABR) remains the gold standard technique of breast reconstruction, providing a durable, natural, and aesthetically pleasing result. However, some patients may not be candidates for a traditio…
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DIEP Flap versus PAP Flap versus LAP Flap: A Propensity-Matched Analysis of Aesthetic Outcomes, Complications, and Satisfaction.
[BACKGROUND] As free breast reconstruction options evolve, a patient- and body-centric approach can distinguish refined aesthetic outcomes. Although deep inferior epigastric perforator (DIEP), profunda artery perforator (PAP), and lumbar ar…
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Long-term Implications of Cosmetic Breast Surgeries on Subsequent Breast Reconstruction.
[BACKGROUND] Cosmetic breast surgeries such as augmentation, mastopexy, and reduction are common aesthetic medical procedures for enhancing physical appearance. Despite their popularity, the influence of these surgeries on subsequent breast…
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Modern Approaches to Alternative Flap-Based Breast Reconstruction: Stacked Flaps.
Total breast reconstruction following mastectomy requires multiple components to achieve an aesthetic result. In some situations, significant skin is required to provide the needed surface area to allow breast projection and breast ptosis. …
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Abandoning the SIEA Flap for the Dual-Plane DIEP Reduces Fat Necrosis and Flap Failure.
[BACKGROUND] Despite its limitations in abdominally based breast reconstruction, using the superficial inferior epigastric artery (SIEA) flap or system can be advantageous in specific clinical scenarios. To optimize outcomes in these cases,…
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Surgical Outcomes of Autologous Breast Reconstruction in Low Body Mass Index Patients: Beyond the Standard DIEP Flap.
[BACKGROUND] Autologous breast reconstruction provides higher satisfaction than implant-based reconstruction in women with low body mass index (BMI). However, the accepted standard of microvascular breast reconstruction, the deep inferior e…
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Deliberate Practice in DIEP Flap Breast Reconstruction: An Immediate and Sustained Decrease in Morbidity and Operative Time.
[BACKGROUND] Deep inferior epigastric perforator (DIEP) flaps are nuanced, multistep, complex procedures. Recent studies have hinted that operational flow can be a sensitive barometer for safety, efficiency, and overall outcomes. The author…
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Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements.
Free tissue transfer is a cornerstone of complex reconstruction. In many cases, it represents the last option available for a patient and their reconstruction. At high-volume centers, the risk of free flap failure is low but its occurrence …
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Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction.
[BACKGROUND] The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and ob…
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Economic Impact of Refinements in ERAS Pathways in DIEP Flap Breast Reconstruction.
[INTRODUCTION] Enhanced recovery after surgery (ERAS) protocols at our institution have led to an expected decrease in hospital length of stay and opioid consumption for patients treated with deep inferior epigastric perforator (DIEP) flap…
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Increased Opioid Consumption following DIEP Flap Breast Reconstruction: Effect of Depression and Anxiety.
[BACKGROUND] Enhanced Recovery After Surgery (ERAS) protocols have decreased postoperative opioid consumption and hospital length of stay in deep inferior epigastric perforator (DIEP) flap breast reconstruction. We aim to evaluate whether …
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Asymmetric Four-Flap Breast Reconstruction with DIEP Flaps and PAP Flaps.
[SUMMARY] Autologous breast reconstruction is considered superior to alloplastic options. In cases of large-volume breast reconstruction, stacked flaps from a single area or multiple donor areas are required. In bilateral stacked four-flap …
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Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery.
[BACKGROUND] In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought…
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Operative Time Predicts Postoperative Outcomes in Bilateral DIEP Flap Reconstruction: Multivariate 1000 Flap Analysis.
[UNLABELLED] Skin-to-skin operative time (OT) as a risk factor for adverse postoperative outcomes in microvascular breast reconstruction has not been thoroughly investigated. This study evaluates OT's impact on length of stay (LOS), overall…
- Reply: Intraoperative Assessment of DIEP Flap Breast Reconstruction Using Indocyanine Green Angiography: Reduction of Fat Necrosis, Resection Volumes, and Postoperative Surveillance.
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Intraoperative Microvascular Complications in Autologous Breast Reconstruction: The Effects of Resident Training on Microsurgical Outcomes.
[BACKGROUND] Academic medical centers with large volumes of autologous breast reconstruction afford residents hand-on educational experience in microsurgical techniques. We present our experience with autologous reconstruction (deep inferi…
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Simultaneous Circumferential Body Lift and Four-Flap Breast Reconstruction Using Deep Inferior Epigastric Perforator and Lumbar Artery Perforator Flaps.
The ideal autologous breast reconstruction provides a long-lasting and aesthetically pleasing result. The deep inferior epigastric perforator (DIEP) flap remains the gold standard for breast reconstruction; however, in a subset of patients,…
- Reply: Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging.
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Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification.
[BACKGROUND] This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Abdominal wall morbidities are categorized, and an algorithm for management is provided.…
- Reply: Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging.