Enhancing Aesthetics in Bilateral DIEP Flap Breast Reconstruction: the Role of Tissue Pre-Expansion.

[BACKGROUND] Achieving symmetrical outcomes in bilateral autologous breast reconstruction is challenging, particularly in cases of asymmetrical recipient sites. Tissue pre-expansion is proposed to improve aesthetics by enlarging the skin envelope for refined breast shaping. This study examines its efficacy in bilateral DIEP flap reconstructions.

[METHODS] This study systematically evaluated 43 patients that underwent bilateral DIEP flap breast reconstruction between 2004 and 2021. The efficacy of tissue pre-expansion in enhancing aesthetic outcomes, patient demographics, and complications were analysed. Aesthetic outcomes were measured using the aesthetic item score (AIS).

[RESULTS] Patients had an average age of 48.67 years (range: 29-79) and BMI of 27.08 (range: 23-36). Of these, 65.12% had undergone radiotherapy and 83.72% chemotherapy before reconstruction. Patients predominantly received secondary breast reconstruction (72.02%). Pre-expansion significantly improved breast symmetry and the overall aesthetic result (OAR) in cases of asymmetrical recipient-site conditions (3.76 vs. 3.16, p = 0.006 and 7.08 vs. 6.27, p = 0.03, respectively). There was a non-significant trend towards better breast form and volume, with no effect on scarring. For patients with symmetrical recipient-site conditions, pre-expansion did not significantly impact the aesthetic outcome. No significant differences in complication rates were observed.

[CONCLUSION] Tissue pre-expansion significantly enhances aesthetic outcomes of bilateral autologous breast reconstruction, notably breast symmetry and OAR, in patients with asymmetrical recipient-site conditions. However, careful patient selection and preoperative planning are essential for leveraging pre-expansion's benefits, emphasizing the importance of informed decision-making and expectation management. This publication/study investigates the efficacy of tissue pre-expansion in enhancing aesthetic outcomes for bilateral DIEP flap breast reconstructions. Detailed analysis of 43 patients that received bilateral DIEP reconstruction with and without pre-expansion. Finds significant improvements in breast symmetry and overall aesthetic rating (OAR) for patients with asymmetrical recipient-site conditions.

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