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Traditional wide‑undermining abdominoplasty is associated with large dead spaces, increased
seroma risk, and insufficient control of inferior bulging. It may also compromise vascularity,
increasing the likelihood of skin necrosis and wound dehiscence. These limitations are particularly
relevant in DIEP donor‑site closure, where preservation of abdominal wall integrity and achieving a
low, reliable, and aesthetic scar are essential.

The technique combines transverse plication of the lower musculo‑aponeurotic unit, derived from
the TULUA technique originally described by Villegas, which is the primary contributor to
dead‑space reduction, inferior bulging control, and decreased lower‑incision tension. High superior
tension, adapted from the Haute Tension Supérieure concept of Pascal and Le Louarn, providing
superior tension redistribution and improved upper abdominal definition. Scarless
neo‑umbilicoplasty, providing a more natural and reliable umbilical outcome. Pubic suspension,
refining inferior contour and reducing wound tension and dead space. These were complemented by
targeted liposuction when necessary to harmonize contours and optimize tension distribution.

The combined approach improves upper abdominal definition, flattens and stabilizes the lower
abdomen, enhances pubic contour, and yields a natural umbilicus. Functionally, it eliminates
inferior bulging, strengthens the musculo‑aponeurotic layer, reduces lumbar strain, and improves
core stability. Safety benefits include major dead‑space reduction, fewer seromas, minimal skin
necrosis, fewer dehiscences, and lower, more reliable and aesthetic scarring.

This integrated approach demonstrates that TULUA‑derived transverse plication, as the main
mechanism for dead‑space reduction and lower‑incision tension control, combined with high
superior tension, neo‑umbilicoplasty, pubic suspension, and targeted liposuction, provides a safer,
more predictable, and aesthetically superior alternative to traditional abdominoplasty and optimizes
DIEP donor‑site management.

Seroma at the abdominal donor site is a frequent complication following Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. Reported incidences vary widely, reflecting differences in surgical technique, patient characteristics, and outcome reporting. Consequently, this proportional meta-analysis aimed to estimate the pooled incidence of donor-site seroma and evaluate potential risk factors.

A systematic literature review of PubMed, Web of Science, and the Cochrane Library was performed up to June 2025. Studies reporting abdominal donor-site seroma rates following DIEP flap reconstruction were included. Data were pooled using a random-effects model (DerSimonian–Laird), and heterogeneity was assessed using I² and τ² statistics. Univariable meta-regression analyses explored associations between smoking status and diabetes on seroma occurrence.

The search identified 1,345 unique records, of which 71 studies met the inclusion criteria, comprising 12,739 patients and 16,915 DIEP flaps. A total of 736 seromas were reported, yielding a pooled incidence of 6% (95% CI: 4–7%). Heterogeneity was substantial (I² = 85.3%, τ² = 0.05, p < 0.001). The mean body mass index and age were 27.2 kg/m² and 50.4 years, respectively. Meta-regression showed no significant association between seroma occurrence and smoking (p = 0.57) or diabetes (p = 0.07).

Donor-site seroma occurs in 6% of DIEP flaps. The absence of associations with smoking or diabetes in meta-regression suggest that seroma formation may rather be influenced by technical and perioperative factors than by comorbidities.

Dermabond Prineo is a wound closure system combining polyester mesh with 2-octylcyanoacrylate glue, offering rapid application and a water-tight seal as distinct advantages. Allergic Contact Dermatitis (ACD), a type IV hypersensitivity reaction, is a recognized complication. This paper evaluates the incidence, presentation, and management of Prineo-related reactions within a specialized breast reconstruction unit.

A retrospective audit was conducted of patients undergoing breast surgery (including DIEP flaps and non-free flap procedures) between January 2025 and January 2026. Data points included time to ACD onset, prior acrylate exposure (e.g., eyelash or nail glue), ACD treatment modalities, and any specific sequelae of patient's ACD reaction.

Out of 393 patients treated with Prineo, 8 developed ACD (2% incidence). The median age was 45.5 years, and the median time to reaction was 13 days (range 4–40). Reactions consistently involved all sites of Prineo application. Management included mesh tape removal in clinic, antihistamines (62.5%), and topical steroids (87.5%).

Notably, 4 patients were initially misdiagnosed with cellulitis, leading to intravenous antibiotics being administered in two cases. One patient required a return to the operating room for exploration due to severe swelling mimicking hematoma or zonal necrosis. In 50% of cases where data was available, patients reported prior acrylate exposure. One patient experienced post-inflammatory hyperpigmentation which resolved after 12 months.

Despite a relatively low 2% incidence, Prineo-related ACD has the potential to mimic infection, leading to unnecessary surgery and/or intravenous antibiotics. Our unit has introduced mandatory allergy screening and a protocol to remove residual chlorhexidine from patient skin before Prineo application to address a potential chemical interaction, as advised by the manufacturers based on recent findings. While Prineo offers clear benefits, one must be aware of the potential for severe skin reactions in patients, previously exposed or otherwise.