Prepectoral Implant Placement with Pedicle Division and Resorbable Mesh Reinforcement for DIEP Flap Augmentation.

[BACKGROUND] The purpose of this study was to review the safety and efficacy of delayed prepectoral deep inferior epigastric perforator (DIEP) flap augmentation in both primary DIEP flap augmentation and revision DIEP flap augmentation (ie, prepectoral conversion).

[METHODS] A retrospective review of records was performed on all patients who underwent primary and revision breast reconstruction from August of 2018 to August of 2024 performed by a single surgeon.

[RESULTS] A total of 585 abdominally based free flaps were performed by the author during the aforementioned 6-year period. Thirty-two of these autologous reconstructions (5.5%) proceeded to undergo prepectoral DIEP flap augmentation. Thirty-two primary DIEP flaps and 8 prepectoral conversions (subpectoral DIEP flap augmentation to prepectoral DIEP flap augmentation) were performed. There were no acute flap-related complications caused by implant placement. Two implants experienced inferior malposition prompting the adoption of TIGR matrix support later in the series. Following the adoption of a resorbable mesh for soft-tissue support, there were no further cases of inferior malposition.

[CONCLUSIONS] Delayed prepectoral DIEP flap augmentation is a safe and effective means of hybrid breast reconstruction. Inferior soft-tissue support should be strongly considered, particularly with use of smooth implants, in this setting.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.