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The deep inferior epigastric artery perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and muscle-sparing design. However, donor site results regarding aesthetic outcome are often less favorable. We therefore aimed to identify crucial factors that might increase the risk for abdominal bulging and an impaired aesthetic appearance. We conducted a multicenter study evaluating all patients receiving autologous breast reconstruction using a DIEP flap between 2013 and 2017. Medical records were analyzed with special attention to flap technique, number of perforators, localization of perforator, and donor site complications. In addition, the aesthetic appearance of the abdominal donor site was evaluated by blinded clinicians at one-year follow-up. A total of 242 patients underwent DIEP flap breast reconstruction. Abdominal bulging occurred in 7%. Further subgroup analysis revealed a significant correlation between abdominal bulging and two or more perforators (P = .003), the use of lateral row perforators (P = .009), and a higher BMI (P = .002). Obesity (P = .003) and higher patient's age (P = .003) could be identified as risk factors for an undesirable appearance of the donor site. We recommend the use of a medial-row single perforator whenever possible in order to optimize donor site morbidity and decrease the risk of abdominal bulging. Proper patient selection and careful donor site closure following a standardized approach should be performed to limit the risk of aesthetically undesirable results., (© 2020 Wiley Periodicals LLC.)

Cosmetic Breast Augmentation without Silicone Implants Abstract. Cosmetic breast augmentation procedures without silicone implants are becoming increasingly popular. Mastopexy can be adapted to the needs of the patient and usually result in an at least optical augmentation. Lipofilling is a safe procedure in reconstructive and aesthetic breast surgery and can help to restore natural appearance, compensate volume deficiencies, and correct asymmetries, that may be congenital or a consequence of prior surgeries. Cosmetic breast augmentation of very small breasts or when aiming at higher breast volumes using lipofilling only are usually combined with procedures for tissue expansion in order to increase the take rate of the injected fat. Hyaluronic acid injections is no valid alternative and are not recommended for cosmetic breast augmentation.