Clinical Research Directory

Inclusion Criteria: * Female, aged \>18 years. * BMI between \> 22 and \<35 kg/m2 * History of breast cancer treated with mastectomy (minimally 3 months after mastec-tomy) and post mastectomy chest wall radiotherapy (completed ≥6 months before en-rollment). * May include contralateral/bilateral prophylactic mastectomy if at least one side had cancer and radiation. * Desires autologous breast reconstruction and accepts randomization between AFT and DIEP. * Medically fit for surgery (ASA I-III). * Sufficient donor tissue for both AFT (enough fat) and DIEP (suitable abdominal tissue and vasculature). * No evidence of active cancer at enrollment; remission confirmed. * Able to wear the EVE device (if randomized in AFT). * Capable of understanding study information and questionnaires (Dutch or English), willing to give informed consent, and able to comply with follow-up. Exclusion Criteria: * Prior autologous breast reconstruction on the intended side. BMI \<22 or \>35 kg/m2 * Contraindication to DIEP flap (e.g., prior abdominoplasty or abdominal scars affecting perforators). * Contraindication to AFT (e.g., insufficient fat or conditions impairing fat graft viability). * Current chemotherapy or completed less than 4 weeks prior to enrollment. * Serious uncontrolled comorbidities making elective surgery unsafe (e.g., unstable heart disease, severe coagulopathy, end-stage organ failure). * Active smoker or not abstinent for at least 6 weeks pre-operatively. * Pregnant at time of enrollment. * In case low compliance is expected or an inability to comply with study protocol, including unwillingness to undergo either AFT or DIEP, or inability to complete follow-up (due to language, cognitive issues, or relocation plans). * Previous enrollment in this trial (patients can only be included once, even if later presenting for contralateral reconstruction). * Allergy to lidocaine or silicone