Buried DIEP Flaps Show Similar Complication Rates to Skin Paddle Flaps

Autologous breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is a well-established procedure for post-mastectomy restoration, valued for its durable and natural-feeling results [1, 2, 3]. Despite its advantages, clinicians remain focused on mitigating risks such as flap loss and fat necrosis [4, 5, 6]. Surgical outcomes have been enhanced by technologies like preoperative computed tomography angiography (CTA), which improves perforator selection and has been shown to reduce operative time and flap loss rates [7, 8]. Similarly, intraoperative tools such as indocyanine green angiography (ICG-A) help assess tissue perfusion, significantly decreasing rates of fat necrosis and reoperation [9]. Building on these advances, surgeons are now evaluating techniques that could further refine the process, specifically questioning the necessity of an external skin paddle for monitoring and exploring the safety of completely burying the flap to facilitate a single-stage reconstruction.