# Comparison of methods for inframammary fold fixation of deep inferior epigastric perforator flap breast reconstruction

## TL;DR

This study compares different surgical methods for fixing the inframammary fold in breast reconstruction using DIEP flaps, finding that the delayed one-stage method provides better results.

## Contribution

The paper introduces a quantitative comparison of IMF fixation outcomes across three DIEP flap reconstruction methods.

## Key findings

- The delayed one-stage (de-epithelialized) method showed better IMF fixation compared to immediate and two-stage methods.
- Additional IMF procedures during flap revision improved IMF height outcomes across all methods.
- The reconstructed IMF height remained lower than the healthy side in all methods.

## Abstract

Various methods for inframammary fold (IMF) fixation in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction have been reported. This quantitative study focused on the comparison of IMF fixation results between immediate one-stage (internal fixation), delayed one-stage (de-epithelialized method), and two-stage (capsule fixation) reconstruction.

A retrospective study of 34 patients who underwent unilateral DIEP flap reconstruction was conducted. The IMF height, grouped by reconstruction methods, was measured from the standardized clinical photographs >6 months after the DIEP flap reconstruction (post-DIEP) and >6 months after the flap revision surgery (final), and compared with the healthy side.

In the order of immediate one-stage, delayed one-stage, and two-stage reconstruction, respectively, the average (± standard deviation) post-DIEP IMF heights were −1.60 ± 0.65 cm, −0.19 ± 1.16 cm, and −1.40 ± 1.11 cm, and the average final IMF heights were −1.20 ± 0.44 cm, −0.19 ± 0.52 cm, and −0.68 ± 0.98 cm.

After DIEP flap breast reconstruction, the IMF of the reconstructed side tends to be lower than the healthy side. The de-epithelialized method used in delayed one-stage reconstruction showed relatively good IMF fixation after DIEP flap reconstruction compared with other reconstruction methods. By performing additional IMF procedures during flap revision surgery, the average IMF height ranged from −1.2 to −0.19 cm compared with the healthy side.