From breast cancer to DIEP Mommy Makeover: an onco-aesthetic reconstructive approach

BACKGROUND: Autologous breast reconstruction using the Deep Inferior Epigastric Perforator (DIEP) flap is recognized as the gold standard in post-mastectomy reconstruction. Beyond restoring breast volume, DIEP flap techniques may also contribute to overall body aesthetics and psychological recovery, especially when combined with abdominal contouring and contralateral symmetrisation procedures. This paper aimed to evaluate clinical, aesthetic, and psychological outcomes of immediate DIEP flap breast reconstruction, with a specific focus on global body image, satisfaction, and Appearance Investment (AI), exploring the concept of a "DIEP Mommy Makeover" approach. METHODS: A retrospective cohort study was conducted on 73 patients undergoing immediate DIEP flap reconstruction between 2019 and June 2024. Outcomes were assessed using validated tools: BREAST-Q (breast satisfaction), BODY-Q (body and abdominal satisfaction), and ASI-R (Appearance Investment) at baseline, 6 and 12 months. Multivariable regression analyses identified predictors of outcomes. RESULTS: Significant improvements were observed across all BREAST-Q and BODY-Q domains at 12 months (p < 0.001). AI scores increased from 41.2 ± 11.8 to 61.3 ± 13.2 (p < 0.001). Combined contouring procedures and NAC reconstruction were strong positive predictors, while complications, radiotherapy, and higher BMI negatively influenced outcomes. CONCLUSION: Immediate DIEP flap breast reconstruction, when integrated with aesthetic procedures, offers holistic benefits beyond oncologic restoration. The "DIEP Mommy Makeover" approach enhances patient satisfaction with body image and self-perception, underscoring the importance of aesthetic considerations in reconstructive planning to support both physical and psychological recovery.