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Robotic Repair: An Alternative Technique for Rectus Diastasis and Abdominal Bulge Following DIEP Flap Breast Reconstruction. Aesthet Surg J 2024 Aug 20;44(9):957-964

Date

03/19/2024

Pubmed ID

38500393

DOI

10.1093/asj/sjae059

Scopus ID

2-s2.0-85201836679 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. Despite advances in perforator dissection, abdominal morbidity still occurs. Traditional rectus diastasis (RD), abdominal bulge, and hernia repair with open techniques are associated with higher complication rates and recurrence.

OBJECTIVES: We present a novel case series of robotic repair of symptomatic RD and/or abdominal bulge with concurrent hernia following DIEP flap surgery.

METHODS: A single-center, retrospective review was conducted of 10 patients who underwent bilateral DIEP flap breast reconstruction and subsequent robotic repair of RD and/or abdominal bulge and hernia. Preoperative demographics and postoperative clinical outcomes were reviewed. RD up to 5 cm, abdominal bulge, and any concurrent ventral/umbilical hernias were repaired robotically with retrorectus plication and macroporous mesh reinforcement.

RESULTS: The average age and BMI were 49 years (range 41-63) and 31 kg/m2 (range 26-44), respectively. The average number of perforators harvested per flap was 2.5 (range 1-4). Average RD and hernia size were 3.95 cm (range 2-5) and 5.8 cm2 (1-15), respectively. Eight patients stayed 1 night in the hospital, and 2 went home the same day as the robotic repair. No patients were converted to open technique and none experienced complications within 30 days.

CONCLUSIONS: For patients who experience donor site morbidity following DIEP flap breast reconstruction, minimally invasive robotic repair of RD and/or abdominal bulge with hernia can be performed with mesh reinforcement. This technique is effective, with low complication rates, and should be considered over open repair.

Author List

Herold K, Stoddard T, Rodriguez-Unda N, LoGiudice J, Hettinger P, Higgins RM, Doren EL

Authors

Rana Higgins MD Associate Professor in the Surgery department at Medical College of Wisconsin
Nelson Agustin Rodriguez-Unda MD Assistant Professor in the Plastic Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Diastasis, Muscle
Epigastric Arteries
Female
Humans
Mammaplasty
Middle Aged
Perforator Flap
Postoperative Complications
Rectus Abdominis
Retrospective Studies
Robotic Surgical Procedures
Surgical Mesh
Treatment Outcome