Techniques of inserting deep inferior epigastric perforator flap obliquely in immediate breast reconstruction after total mastectomy

Objective: This study aimed to share the experience of inserting a deep inferior epigastric perforator (D.I.E.P) flap obliquely in imme-diate breast reconstruction after total mastectomy.Method: Forty patients underwent immediate breast reconstruc-tion with flap D.I.E.P after total mastectomy. The flaps were placed obliquely, with the upper edge facing downward and inward. Af-ter being placed in the recipient region, parts of the flap at both ends were removed, the upper end was fixed into the II-III inter-costal space next to the sternum, and the lower end was folded to create a projection of the lateral lower pole of the breast. The flap pedicle was anastomosed to the thoracodorsal vessels (TDVs) if the contralateral flap pedicle was used; conversely, the mammary ves-sels (IMVs) were used. Satisfaction with breast shape was assessed after 6 months using the BREAST-Q questionnaire.Results: A total of 37/40 flaps were well vascularized; 36/37 pa-tients with a survival flap were interviewed, showing that the av-erage BREAST-Q evaluation score of satisfaction with breast shape was 62.22 (51-78). The number of answers for satisfied and very satisfied with breast shape accounted for 94.44%.Conclusion: Inserting the D.I.E.P flap obliquely has the advantage of being easy to shape the breast contour, creating a moderate pro-jection and symmetry to the opposite breast. The author suggested using the IMVs as the receiving vessels when using the pedicle of the flap on the ipsilateral side and the TDVs when the contralateral pedicle flap was used.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )