The SEED Protocol Prelaminated DIEP Flap: Serial Expansion of the Epigastric Donor Site

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Problem Addressed: The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction, yet thin patients have traditionally been excluded due to insufficient abdominal donor volume in Hartrampf zones I–IV. We describe a novel technique — the SEED (Serial Expansion of the Epigastric Donor site) protocol — in which serial abdominal fat grafting pre-laminates the DIEP flap prior to transfer, expanding the donor site in thin patients who would otherwise lack adequate volume at any traditional donor site, including the thighs. Technique: Six patients with low abdominal fat content who desired autologous breast reconstruction were identified. These patients underwent an average of 2.16 fat grafting sessions using the MTF lipografter system to the lower abdomen from multiple regions including hips, flanks, upper abdomen and thighs. The average fat grafting volume at each session was 411.9 cc with an average of 32.2 days between each session. Fat grafting was performed in both the subscarpal and suprascarpal planes. With an average of 30.6 days following the final fat grafting session, we proceeded with DIEP flap reconstruction in the usual manner. Five cases were bilateral and one case was a unilateral bipedicle flap. Outcomes: This is a single surgeon case series of six patients treated with a novel technique utilizing serial abdominal fat grafting in a staged approach to DIEP flap breast reconstruction. All patients were noted to be poor traditional candidates for DIEP flap reconstruction due to insufficient abdominal subcutaneous tissue. The average BMI was 26.7. We evaluated pre- and post fat grafting volumetrics with CT scans which demonstrated a substantial increase in fat volume within the pre-laminated flap (data collection is ongoing and will be presented at the meeting). BMI prior to each procedure was documented to account for confounding weight fluctuations. Previous fat grafting was not noted to increase flap dissection difficulty. Average length of stay following free flap reconstruction averaged 3.6 days. 30 day morbidity revealed no complications in five of the patients. One patient had mild wound dehiscence on the irradiated breast side requiring local wound care. No complications were noted from fat grafting. Using the BREAST-Q Reconstruction questionnaire, patient satisfaction was determined to be high with special mention of improved contour of suction lipectomy sites (data collection is ongoing). With fine tuning of this technique, the operating surgeon was highly satisfied with the results.

Volume

14

Issue

S4

First Page

10

Last Page

11

Comments

Michigan Academy of Plastic Surgeons Annual Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276716.55024.8d

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