When South Korea's 2024 medical staffing crisis limited access to immediate deep inferior epigastric perforator (DIEP) flap reconstruction, some patients who preferred a DIEP flap received direct-to-implant (DTI) reconstruction instead.
Dr. Jin-Woo Park is assistant professor and department chief of plastic and reconstructive surgery at Ewha Womans University Mokdong Hospital. He presented ‘When preference was constrained: how a system-level crisis changed my breast reconstruction practice’ at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS). The meeting was held October 15 to 18, 2026, in Houston, Texas. His talk was part of the session ‘Gonna be, gonna be golden: overcoming disasters of the masters.’ He described how that change in plan affected outcomes, counseling, and his own surgical practice.
Did Losing Access to DIEP Flaps Lower Patient Satisfaction?
The crisis allowed Dr. Park's team to study a long-standing question: if a patient's preferred operation cannot be done, will satisfaction be lower? His team used a clear counseling pathway and recorded how each patient decided. In a BREAST-Q cohort, the selected groups he compared showed no statistically significant differences in patient characteristics or in short-term satisfaction and quality-of-life scores.
An initial preference, Dr. Park noted, forms before a patient has experienced either reconstruction, and transparent re-counseling can help patients reconsider the available pathways. ‘Some patients have a strong reservation about implants and may usually believe that reconstruction with their own tissue must be better...,’ he said. ‘But the first preference may not fully reflect a true priority. A clear discussion of benefits and risks can help patients make a more informed choice.’
Dr. Park Now Refines Both Implant-Based Shaping and Flap Inset
Before the crisis, Dr. Park had more confidence in autologous breast shaping. During it, he paid greater attention to implant-based contour refinement, and he now counsels more evenly on DTI and autologous reconstruction. Greater reliance on DTI led him to new techniques and research on implant-based shaping. ‘This experience changed how I think about patient outcomes, surgical practices, and shared decisions,’ he said.
He also shared a personal failure: during one of his early independent cases, a flap was lost after venous compromise. He emphasized structured microsurgical training and careful flap inset and monitoring.
He closed with 3 messages for colleagues starting out: ‘First, we should explain the facts clearly and make objective clinical judgments without steering patients toward a decision based on our own preferences. Second, structured training can help us become independent surgeons earlier and more safely. Third, in flap-based breast reconstruction, we need to carefully consider the flap inset.’
Abbreviations: DIEP, deep inferior epigastric perforator; DTI, direct-to-implant.