Comparative Analysis of Aesthetic Abdominoplasty Versus Simple Abdominal Closure in Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

Abstract

<h4>Background</h4>Autologous breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is considered the gold standard for natural and lasting results. Recent focus has shifted toward improving donor-site aesthetics. This retrospective study compared standard versus aesthetic abdominal wall closure techniques.<h4>Methods</h4>We analyzed 46 patients who underwent DIEP flap breast reconstruction at Cleveland Clinic Abu Dhabi between 2021 and 2024. Group 1 (n = 21) received standard closure with Vicryl fascial sutures, interrupted quilting sutures, and drains. Group 2 (n = 25) underwent aesthetic closure with barbed quilting sutures along the linea alba and semilunaris, optional flank liposuction (24%), and selective drain use. Prophylactic mesh was placed in both groups. Outcomes included operative time, hospital stay, complications, and aesthetic assessments at 6 months.<h4>Results</h4>Group 2 had a significantly longer operative time (524 versus 435 min, <i>P</i> = 0.01), with no significant difference in hospital stay (5.2 versus 5.6 d, <i>P</i> = 0.62). Aesthetic satisfaction scores were modestly higher in group 2 for both patients (7.24 versus 6.86, <i>P</i> = 0.86) and surgeons (7.84 versus 7.57, <i>P</i> = 0.58), though not statistically significant. Complication rates were comparable, with no flap loss, bulging, or hernia in either group.<h4>Conclusions</h4>Aesthetic closure may enhance donor-site contour in selected patients, particularly those with lower body mass index and localized adiposity. However, given the marginal aesthetic improvement and increased operative time, its routine use is not justified.