Subcutaneous Pre-expansion of Mastectomy Flaps Before Breast Reconstruction With Deep Inferior Epigastric Perforator Flaps
Bibliographic record
Abstract
INTRODUCTION: Free tissue transfer and tissue expansion are important tools in the reconstructive surgeon's armamentarium, yet are not often used in conjunction. Although tissue transfer has its advantages, the patch-like appearance of the skin paddle on the breast can be unappealing. OBJECTIVE: To present our clinical experience of using subcutaneous breast tissue expansion before reconstruction with deep inferior epigastric perforator (DIEP) flaps, and to show how this technique eliminates the patch-like appearance of the skin paddle. METHODS: Five patients underwent delayed breast reconstruction using a 3-stage approach. During the first stage, tissue expanders were placed in the subcutaneous plane beneath the mastectomy flaps. After complete tissue expansion, the second stage involved removal of the tissue expanders and reconstruction of the breasts by burying deepithelialized DIEP flaps beneath the pre-expanded skin flaps. Revisions and nipple reconstructions were carried out in the third stage. Retrospective analysis of patients' characteristics, breast history, surgical stay, complications, and outcomes were performed. RESULTS: The patients were, on average, 49 years of age, with an average body mass index of 26.3. One patient underwent bilateral breast reconstruction whereas the rest had unilateral reconstructions. Two patients had minor complications. There were no DIEP failures or take-backs. CONCLUSION: Using subcutaneous breast tissue expansion followed by DIEP flap reconstruction can be performed safely, offering patients a completely autologous breast reconstruction with low morbidity, as well as eliminating the classical patch-like appearance of flap reconstructions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".