Enhancing Breast Reshaping in Massive Weight Loss Patients: The Post-Bariatric DIEP Approach.

[BACKGROUND] Massive weight loss (MWL) patients often experience breast sequelae characterized by difficult-to-treat emptying and ptosis due to altered skin quality. Silicone prosthesis use is associated with a high rate of ptosis recurrence. The use of DIEP flap allows simultaneous treatment of breast and abdominal deformities. This study aims to present our experience using the DIEP-free flap as an autologous breast prosthesis for volumetric breast augmentation in the postbariatric population.

[METHODS] This study involved all postbariatric patients who underwent breast reshaping using a double DIEP-free flap. Patient demographics, operative details, and postoperative outcomes were evaluated. Patients filled out BREAST-Q and BODY-Q surveys both preoperatively and after 6 months to study the rate of satisfaction.

[RESULTS] Twenty patients underwent breast reshaping with double DIEP-free flap between September 2020 and October 2023. The average age was 30 years, with an average weight loss of 52.2 kg. Sleeve gastrectomy was the most common bariatric surgery procedure (75%). The average duration of surgeries was 461.38 min. The average length of stay was 6.5 days. Two flaps required surgical revision, with one flap loss. Two complications have been registered for the donor site, one liponecrosis with wound dehiscence and one abdominal bulging. Statistically significant improvements were observed in satisfaction with breast appearance and psychological, physical, and sexual well-being.

[CONCLUSIONS] In the postbariatric population, the DIEP flap represents a safe and reproducible surgical technique for addressing breast deformities. Autologous volumetric augmentation offers harmonious and stable long-term outcomes without secondary sequelae at the donor site.