Stepwise Assessment and Full Evaluation in DIEP flap after abdominal liposuction

The use of DIEP flaps in patients with a history of abdominal liposuction remains controversial due to concerns about potential damage to perforator vessels, which are crucial for the flap's perfusion. Some studies suggest liposuction does not significantly harm perforator vessels, allowing for successful breast reconstruction, while others indicate potential risks, underscoring the need for thorough preoperative assessment and planning, including consideration of the superficial venous system, which may be compromised due to subcutaneous scarring from liposuction or from direct damage by the cannula. This study aims to develop a decision-making algorithm for autologous breast reconstruction using DIEP flaps in patients with a history of abdominal liposuction. It is a retrospective, monocentric observational clinical study conducted at the Plastic Surgery Unit of Policlinico Gemelli in Rome from 2011 to 2024. The study includes female patients over 18 years with clinical indications for DIEP flap reconstruction and a history of abdominal liposuction. Data collected from patient records encompass demographic information, surgical details, preoperative imaging results, and postoperative outcomes. Preoperative evaluations involve abdominal angio-CT and color Doppler ultrasound to assess the integrity of perforator vessels and the superficial venous system. Intraoperative assessments include clinical evaluation and indocyanine green fluorescence angiography. Despite the challenges posed by previous abdominal liposuction, the study finds that DIEP flap reconstructions can be successful with thorough preoperative planning and intraoperative assessments. The SAFE-DIEP protocol, which incorporates comprehensive evaluation of both arterial and venous systems, proves effective in mitigating complications. Notably, no flap failures or significant complications are observed.