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INTRODUCTION: In microvascular breast reconstruction, the focus has shifted to achieving aesthetically pleasing results. Delayed breast reconstruction poses challenges such as ensuring natural ptosis and avoiding a "patch" effect. The Be.A.U.T-I.F.U.L. deep inferior epigastric perforator (DIEP) flap inset, presented here, offers a systematic and sequential seven-step method to optimize breast reconstruction outcomes. METHODS: This approach emphasizes safety during flap harvest using the best (Be.) perforator identified via computed tomography angiography to minimize dissection and ensure solid perfusion. The flap is placed obliquely, directing its tail to the axilla (A.), enhancing upper (U.) pole volume and ptosis. The flap base is tucked-in (T-I.) to increase the projection of the breast mound, and its lateral portion is split as a fishtail (F.): the upper (U.) fin is used to define the lateral inframammary fold and prevent lateral displacement of the reconstructed breast, while the lower (L.) fin is turned under the flap to further improve projection. CONCLUSION: This structured approach, focusing on key breast aesthetics, ensures optimal cosmetic outcomes and can serve for most delayed microsurgical breast reconstruction scenarios. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Coppola et al. (Mon,) studied this question.