{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T02:35:04Z","timestamp":1778121304133,"version":"3.51.4"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Obtaining a natural breast mound shape contributes profoundly to a symmetrical and successful outcome in breast reconstruction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The authors sought to describe a new and efficient technique that enhances breast projection in delayed breast reconstruction employing abdominal free flaps and compare it with the current standard methods utilized.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The charts of 490 consecutive patients who underwent delayed breast reconstruction employing free abdominal perforator flaps were reviewed between 2007 and 2017. Three methods of breast reconstruction were compared: undermining, de-epithelialization, and the \u201chug flap\u201d (HF). In the newly described technique, the caudal mastectomy skin was de-epithelialized, and then the medial and lateral thirds were undermined and folded over to cover the central part. The rates of complications and secondary corrections were analyzed between the 3 groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 570 free abdominal flaps performed. The de-epithelization technique was the most commonly utilized (328 cases) followed by the undermining technique (153 cases). The HF technique was employed in 89 cases. The majority of HFs were performed in unilateral breast reconstruction. Bilateral cases were conducted in only 12 patients. The need for additional fat grafting was significantly (P = 0.003) less required in the HF group compared with the undermining and de-epithelializing groups (12% vs 28% and 21%, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although all breast-enhancing options can be mixed and matched based on the surgeon\u2019s preference and experience as well as each patient\u2019s needs, the HF can be considered as an adjunct tool to provide adequate flap projection and enhance breast symmetry.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjab030","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T18:44:21Z","timestamp":1611427461000},"page":"NP1462-NP1470","source":"Crossref","is-referenced-by-count":4,"title":["The \u201cHug Flap\u201d: Surgical Technique to Enhance the Aesthetic Breast Projection in Autologous Breast Reconstruction"],"prefix":"10.1093","volume":"41","author":[{"given":"Moustapha","family":"Hamdi","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Brussels University Hospital \u2013 Vrij Universiteit Brussel (VUB) , Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Al Harami","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Brussels University Hospital \u2013 Vrij Universiteit Brussel (VUB) , Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadel","family":"Chahine","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Brussels University Hospital \u2013 Vrij Universiteit Brussel (VUB) , Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Giunta","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Brussels University Hospital \u2013 Vrij Universiteit Brussel (VUB) , Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randy","family":"De Baerdemaeker","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Brussels University Hospital \u2013 Vrij Universiteit Brussel (VUB) , Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3465-0752","authenticated-orcid":false,"given":"Assaf","family":"Zeltzer","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Brussels University Hospital \u2013 Vrij Universiteit Brussel (VUB) , Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"issue":"1","key":"2022122411023625200_CIT0001","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":"Allen","year":"1994","journal-title":"Ann Plast Surg"},{"issue":"1","key":"2022122411023625200_CIT0002","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/00006534-199901000-00015","article-title":"Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps","volume":"103","author":"Hamdi","year":"1999","journal-title":"Plast Reconstr Surg"},{"issue":"5","key":"2022122411023625200_CIT0003","doi-asserted-by":"crossref","first-page":"767e","DOI":"10.1097\/PRS.0b013e318267d995","article-title":"Double-pedicled abdominal free flap using an entirely new microvascular combination of DIEP and SIEA vascular pedicles for unilateral breast reconstruction: a novel addition to the Hamdi classification","volume":"130","author":"Rabey","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"2022122411023625200_CIT0004","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1016\/j.bjps.2014.06.008","article-title":"Combination of the superior and inferior pedicle \u201ccontinuities\u201d for anastomosis of an SIEA flap to a contralateral DIEP flap in double-pedicled abdominal free flaps: a further modification of the Hamdi classification","volume":"67","author":"Mohan","year":"2014","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2022122411023625200_CIT0005","first-page":"3","article-title":"Shaping the breast in aesthetic and reconstructive surgery: an easy three-step principle. 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