The combined use of a deep inferior epigastric perforator (DIEP) flap coupled with vascularized inguinal lymph nodes (VILNs) for simultaneous breast and lymphedema reconstruction has already been well established, and promising results have been reported. However, a standardized approach for the planning and shaping of this combined flap is still lacking. We aimed to propose a comprehensive algorithmic approach for delayed unilateral breast and lymphedema reconstruction using a predesigned abdominal flap associated with inguinal lymph node transfer. We present in detail the preoperative measurements and surgical technique of the chimeric flap, which combines a predesigned DIEP template and a preselected inguinal lymph node flap, based on the preoperative computed tomography angiography and SPEC-CT findings, respectively; four different flap types are described according to the location of the pedicles of the two flap components. Our results of a series of 34 consecutive female patients with unilateral mastectomy and arm lymphedema, who underwent this combined predesigned reconstructive procedure, are retrospectively analyzed and reported. We recorded a high survival rate of the chimeric flaps in our series, with only one case of partial ischemic loss of a DIEP skin island. In the majority of our patients, the pedicles of the combined flaps were located in opposite positions. After a mean 35-month follow-up, we recorded a 47% mean volume difference reduction of the lymphedematous compared to the unaffected arm; no donor-site lymphedema was documented. Self-evaluation questionnaires showed high patient satisfaction rates regarding breast reconstruction. This algorithmic approach provides standardized guidance for accurate design and transfer of the DIEP-VILN chimeric flap while achieving highly satisfactory outcomes for both breast and lymphedema reconstruction.

Background: Three-dimensional (3D) imaging enhances surgical planning and documentation in plastic surgery, but high costs limit accessibility. Mobile light detection and ranging (LiDAR) technology offers a potential cost-effective alternative. Objectives: The objective of this research was to evaluate the accuracy and clinical utility of iPhone-based LiDAR scanning for breast measurements compared to traditional methods, and to establish standardized protocols for clinical implementation. Methods: In this prospective validation study, 25 consecutive patients (mean age: 44 years; range: 32-64 years; mean BMI: 23.2 kg/m2) undergoing breast procedures were evaluated with the “3D Scanner App” on the iPhone 15 Pro (Apple Inc., Cupertino, CA). Three standardized measurements (sternal notch-to-nipple, nipple-to-midline, nipple-to-inframammary fold) of LiDAR and manual techniques were compared. Technical error of measurement (TEM) and relative TEM (rTEM) were calculated. Interrater reliability, learning curve assessment, and cost-effectiveness analysis were performed. Results: LiDAR measurements showed very good accuracy for sternal notch-to-nipple (rTEM 1.43%, 95% CI: 1.21-1.65) and nipple-to-midline (rTEM 2.83%, 95% CI: 3.12-3.78) distances. Nipple-to-inframammary fold measurements showed poor accuracy (rTEM 13.05%, 95% CI: 8.21-9.39). Interrater reliability was excellent (ICC = 0.92). Learning curve analysis demonstrated measurement stability after 5 cases. Cost analysis revealed 97.8% reduction in initial investment compared to commercial 3D imaging systems. Conclusions: Mobile LiDAR offers a cost-effective tool for breast surgery planning and documentation. While measurements like sternum-to-nipple and nipple-to-midline are highly accurate, the relatively poor accuracy of nipple-to-IMF highlights limitations with complex curves. As this technology continues to evolve, further improvements in accuracy are anticipated, expanding its role in clinical use. Level of Evidence: 4 (Therapeutic):

Summary: In this study, we report a rare incidence of bilateral hematoma following air travel in a patient who had recently undergone breast augmentation surgery. The case underscores the potential risks associated with flying shortly after such procedures. Through a literature review, we aimed to explore the incidence rates and highlight the need for further research in this area. This case report aims to raise awareness among healthcare professionals and patients about the need for cautious post-surgical travel planning to mitigate the risk of similar complications.