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Dynamic infrared thermography (DIRT) is a non-invasive technique for perforator mapping in Deep Inferior Epigastric artery Perforator (DIEP) flap breast reconstruction. Its accuracy is highly dependent on the cooling technique used to enhance thermal contrast. This study compares eleven cooling techniques based on cooling uniformity, artifact minimization, and usability. Techniques included both conductive and convective approaches and were evaluated using a Pugh Decision Matrix. The top three techniques, including the standard technique, were further assessed in a pilot clinical study. Water-based cooling with neoprene insulation and intensive pre-cooled pad cooling demonstrated the highest uniformity (mean standard deviations of 0.79 and 0.82 °C, respectively) and minimal artifact formation. Pilot clinical validation supported these findings. These techniques offer reliable and practical solutions for enhancing thermal contrast and image clarity in DIRT-based preoperative planning in DIEP flap surgery.
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http://dx.doi.org/10.1016/j.bjps.2025.08.018 | DOI Listing |
Ann Surg Oncol
September 2025
Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Background: Postmastectomy autologous reconstruction (PMAR) is an important component of comprehensive breast cancer care. Previous research has suggested the existence of sociodemographic disparities in complications after immediate PMAR. The objective of this study was to examine the impact of sociodemographic and clinical factors on immediate PMAR postoperative outcomes.
View Article and Find Full Text PDFAnn Plast Surg
September 2025
From the Department of Plastic Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.
Background: Loss of breast sensation following mastectomy and reconstruction significantly impacts quality of life, influencing body image, intimacy, and overall emotional well-being. Despite advances in reconstructive techniques, sensory outcomes remain inconsistent, limiting broader clinical adoption of reinnervation strategies. This educational review synthesizes the current scope of sensory restoration in breast reconstruction, examining approaches to reinnervation, sensory outcome measures, and management of patient expectations.
View Article and Find Full Text PDFInt J Surg Protoc
December 2025
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
Background: End-to-end anastomosis to the internal mammary artery (IMA) is the current standard anastomosis technique for women undergoing autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flap. This approach fails to preserve the length of the IMA, compromising its availability for cardiac surgery use in women who develop coronary heart disease. A viable alternative may be end-to-side anastomosis, but data on its feasibility is currently lacking.
View Article and Find Full Text PDFJ Plast Reconstr Aesthet Surg
August 2025
University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, London, United Kingdom.
Background: In the deep inferior epigastric perforator (DIEP) flap breast reconstruction, fat necrosis is a common and distressing complication for patients. While venous outflow augmentation using the superficial inferior epigastric vein (SIEV) has been suggested to improve some perfusion-related outcomes, its effect on fat necrosis remains insufficiently substantiated.
Methods: A retrospective review was conducted of unilateral, unipedicled DIEP flap breast reconstructions performed between 2012 and 2023 at a tertiary centre in London, United Kingdom.
J Plast Reconstr Aesthet Surg
August 2025
Division of Plastic Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, NY, USA. Electronic address:
Background: Loss of sensation after mastectomy impacts long-term satisfaction, yet thermal sensory outcomes remain understudied. This study compares tactile and thermal recovery following two-stage alloplastic versus neurotized autologous breast reconstruction.
Methods: In this prospective single-institution study, patients underwent mastectomy with either two-stage alloplastic or immediate neurotized DIEP flap reconstruction.