{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T23:42:07Z","timestamp":1766792527844,"version":"3.48.0"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Deep inferior epigastric perforator (DIEP) flap is a common autologous breast reconstruction option. DIEP flap may be performed immediately on the day of mastectomy (immediate DIEP) or at a later date typically following placement of a tissue expander during mastectomy (delayed-immediate DIEP). Preparing internal mammary vessels during microsurgical anastomoses involves prolonged retraction of the breast skin flaps, which can increase tension on acutely ischemic mastectomy skin. The purpose of this study is to investigate whether DIEP flap timing has an effect on mastectomy skin necrosis.<\/jats:p>\n                  <jats:p>A single-center study was performed of patients who underwent immediate or delayed DIEP flap reconstruction over a 3-year period. Patients were divided into two groups: Group I (immediate DIEP flap) and Group II (delayed-immediate DIEP with flap staged separately from mastectomy). The outcomes assessed were breast skin flap necrosis and management of skin flap necrosis.<\/jats:p>\n                  <jats:p>The study included 106 patients (173 flaps) in Group I (49 patients, 80 flaps) and Group II (57 patients, 93 flaps). Mastectomy skin flap necrosis rates were 11.3% (9\/80) for Group I compared to 2.2% (2\/93) of Group II patients (p\u2009=\u20090.025). Skin necrosis necessitating operative debridement was 7.5% (6\/80) in Group I and 1.1% (1\/93) in Group II (p\u2009=\u20090.0499).<\/jats:p>\n                  <jats:p>Immediate DIEP flaps performed on the day of mastectomy have a significantly higher risk of mastectomy skin necrosis. Patients may be counseled that another advantage of performing a DIEP flap on a different day than a mastectomy is to decrease the risk of mastectomy skin necrosis.<\/jats:p>","DOI":"10.1055\/a-2540-1154","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T20:50:46Z","timestamp":1741726246000},"page":"038-043","source":"Crossref","is-referenced-by-count":0,"title":["Effect on Timing of Free Flap Breast Reconstruction on Mastectomy Skin Necrosis"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8707-9230","authenticated-orcid":false,"given":"Shahnur","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Crabtree","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasra N.","family":"Fallah","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan J.","family":"Rinne","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luci","family":"Hulsman","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla S.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kandice K.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel M.","family":"Danforth","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Lester","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aladdin H.","family":"Hassanein","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00000637-199401000-00007","article-title":"Deep inferior epigastric perforator flap for breast reconstruction","volume":"32","author":"R J Allen","year":"1994","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1245\/s10434-014-3494-z","article-title":"A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal?","volume":"21","author":"B P Kelley","year":"2014","journal-title":"Ann Surg Oncol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.bjps.2008.08.019","article-title":"High satisfaction rates in women after DIEP flap breast reconstruction","volume":"63","author":"T H Damen","year":"2010","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/2000656X.2018.1562459","article-title":"Quality of life, patient satisfaction and cosmetic outcome after delayed breast reconstruction using DIEP flap: a 10 years' follow-up survey","volume":"53","author":"B K Skraastad","year":"2019","journal-title":"J Plast Surg Hand Surg"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1055\/s-0041-1742240","article-title":"Advantages of the delayed-immediate microsurgical breast reconstruction: extending the choice","volume":"38","author":"E Pittelkow","year":"2022","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1097\/01.PRS.0000117192.54945.88","article-title":"Delayed-immediate breast reconstruction","volume":"113","author":"S J Kronowitz","year":"2004","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"387","DOI":"10.21614\/chirurgia.112.4.387","article-title":"Immediate-delayed autologous (IDEAL) breast reconstruction with the DIEP flap","volume":"112","author":"S Fertsch","year":"2017","journal-title":"Chirurgia (Bucur)"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/SAP.0000000000000927","article-title":"Considering the optimal timing of breast reconstruction with abdominal flaps with adjuvant irradiation in 370 consecutive pedicled transverse rectus abdominis myocutaneous flap and free deep inferior epigastric perforator flap performed in a Chinese oncology center: is there a significant difference between immediate and delayed?","volume":"78","author":"S He","year":"2017","journal-title":"Ann Plast 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O'Connell","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3109\/2000656X.2016.1170026","article-title":"Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps","volume":"50","author":"T J Lee","year":"2016","journal-title":"J Plast Surg Hand Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1245\/s10434-015-4709-7","article-title":"Skin flap necrosis after mastectomy with reconstruction: a prospective study","volume":"23","author":"C B Matsen","year":"2016","journal-title":"Ann Surg Oncol"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1055\/a-1887-7645","article-title":"A comparative analysis of risk factors for breast skin necrosis following autologous versus device-based breast reconstruction","volume":"39","author":"M Lu Wang","year":"2023","journal-title":"J 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Davies","year":"2011","journal-title":"Breast"},{"issue":"10","key":"ref21","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.bjps.2006.03.057","article-title":"Complications analysis of 266 immediate breast reconstructions","volume":"59","author":"V Pinsolle","year":"2006","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1097\/01.prs.0000232362.82402.e8","article-title":"A single surgeon's 12-year experience with tissue expander\/implant breast reconstruction: part I. 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Surg"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/01.PRS.0000145723.05286.F7","article-title":"The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications","volume":"115","author":"S L Spear","year":"2005","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref33","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1093\/bjs\/znad107","article-title":"Strategies to avoid mastectomy skin-flap necrosis during nipple-sparing mastectomy","volume":"110","author":"T A Moo","year":"2023","journal-title":"Br J Surg"},{"issue":"07","key":"ref34","doi-asserted-by":"crossref","first-page":"e450","DOI":"10.1097\/GOX.0000000000000408","article-title":"Mastectomy weight and tissue expander volume predict necrosis and increased costs associated with breast reconstruction","volume":"3","author":"G C Yalanis","year":"2015","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/GOX.0b013e318294e41d","article-title":"Increased flap weight and decreased perforator number predict fat necrosis in DIEP breast reconstruction","volume":"1","author":"C L Mulvey","year":"2013","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"17","key":"ref36","doi-asserted-by":"crossref","first-page":"4272","DOI":"10.3390\/cancers14174272","article-title":"Complications of immediate versus delayed DIEP reconstruction: a meta-analysis of comparative studies","volume":"14","author":"A S Alves","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s10549-018-4695-0","article-title":"Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions","volume":"169","author":"J Beugels","year":"2018","journal-title":"Breast Cancer Res Treat"},{"issue":"05","key":"ref38","doi-asserted-by":"crossref","first-page":"848e","DOI":"10.1097\/PRS.0000000000009044","article-title":"Prospective longitudinal patient-reported satisfaction and health-related quality of life following diep flap breast reconstruction: effects of reconstruction timing","volume":"149","author":"O Ochoa","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref39","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1007\/s00404-020-05779-w","article-title":"Immediate versus secondary DIEP flap breast reconstruction: a multicenter outcome study","volume":"302","author":"L Prantl","year":"2020","journal-title":"Arch Gynecol Obstet"},{"issue":"03","key":"ref40","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/SAP.0000000000000881","article-title":"The impact of diabetes mellitus on wound healing in breast reconstruction","volume":"78","author":"A Hart","year":"2017","journal-title":"Ann Plast 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