SP14. Low-incision Drainless Abdomen DIEP Flap Combined With Corsetplasty and Diastasis Repair Enhances Aesthetic Outcome at the Donor Site With Shortened Hospital Stay and Decreased Narcotic Consumption

PURPOSE: Autologous breast reconstruction with DIEP flap places strong emphasis on aesthetic outcomes of the breast, which often comes at the expense of a sub-optimal donor site aesthetic result, especially regarding the location of the abdominal scar and abdominal contouring. The “golden ratio” for umbilicoplasty of 1.6 between xiphoid-umbilicus and umbilicus-lower abdominal crease sets an aesthetic goal for placement of the lower abdominal scar within the lower abdominal crease. A drainless abdomen in eligible patients can facilitate earlier postoperative mobilization and decreased pain. We examine the feasibility of a low-incision, drainless abdomen DIEP flap reconstruction with corsetplasty to promote improved functional and aesthetic outcomes. METHODS: 107 patients underwent DIEP flap reconstruction by the senior author from October 2021 to July 2024. 35 patients underwent low-incision drainless abdomen DIEP flap reconstruction, and of these, 18 patients also underwent bilateral corsetplasty in combination with diastasis repair. The incision was placed at the lower abdominal crease, and drainless abdomens included progressive tension and quilting sutures and Prevena incisional wound vac. These are compared to traditional DIEP reconstruction with abdominal drains. Outcomes included: xiphoid margin-umbilicus and umbilicus-lower incision distances, total morphine equivalents (ME) during postoperative stay, length of postoperative stay, and major/minor complications. RESULTS: The average ratio of the xiphoid margin-umbilicus to umbilicus-lower incision distance was 1.63 (average umbilicus-lower incision distance of 8.67 cm ± 1.25). Low-incision drainless complication rates including infection (6.52%), seroma (4.35%), hematoma (0%), and wound dehiscence (6.52%), with and without corsetplasty, were not different from controls. All drainless DIEPs had a significant decrease in morphine equivalents (ME) from traditional DIEP (59.36 ME ± 62.62 vs. 101.92 ME ± 177.27, p = 0.036), and length of stay was shorter (2.04 days ± 0.98 vs. 2.69 days ± 2.03, p = 0.013). CONCLUSION: Our low abdominal scar allows for better concealment under clothing and reflects the lower abdominal crease in the aforementioned “golden ratio” for umbilicus placement. The popularity of DIEP revision with mastopexy and lipoaspiration body contouring makes this procedure akin to a “mommy makeover” with abdominoplasty and breast augmentation. Drainless abdomen DIEP flap consistently yields reduced postoperative morphine equivalents and shorter length of hospitalization, and the addition of a low-incision and corsetplasty does not increase complications compared to traditional DIEP flap. Augmenting a drainless abdomen DIEP with abdominal low incision and corsetplasty further enhances donor site aesthetic outcome.