DIEP flap reconstruction as salvage option for Poland syndrome breast hypoplasia

2020 ◽  
Vol 73 (11) ◽  
pp. 2086-2102
Author(s):  
Nikolaos Lymperopoulos ◽  
Sami Ramadan ◽  
Ommen Koshy
Keyword(s):  
Diep Flap ◽  
Poland Syndrome ◽  
Flap Reconstruction ◽  
Breast Hypoplasia

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

2021 ◽  
Author(s):  
Taehee Jo ◽  
Dong Nyeok Jeon ◽  
Hyun Ho Han
Keyword(s):  
Donor Site ◽  
Wound Dehiscence ◽  
Diep Flap ◽  
Separate Analysis ◽  
Flap Reconstruction ◽  
Average Body Mass Index ◽  
Deep Inferior Epigastric Perforator ◽  
Average Body Mass ◽  
Artery Perforator ◽  
Average Body

Abstract Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

Preoperative computed tomography assessment for a deep inferior epigastric perforator (DIEP) flap: a new easy technique from the Bologna experience

2020 ◽  
pp. 028418512096389
Author(s):  
Matteo Renzulli ◽  
Alfredo Clemente ◽  
Stefano Brocchi ◽  
Chiara Gelati ◽  
Simone Zanotti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diep Flap ◽  
Reconstruction Method ◽  
Branching Pattern ◽  
Flap Reconstruction ◽  
3D Reconstructions ◽  
Deep Inferior Epigastric Perforator

Background Deep inferior epigastric perforator (DIEP) flap reconstruction is the gold standard reconstructive technique for women undergoing breast cancer surgery. A preoperative computed tomography angiography (CTA)-dedicated protocol and 3D reconstructions are mandatory for correct surgical planning. Purpose To evaluate the diagnostic performance of a new preoperative CTA protocol and a new reconstruction method in the assessment of DIEP technique. Material and Methods A total of 263 women (median age 49 years, age range 26–73 years) underwent preoperative CTA examination before DIEP flap breast reconstruction. A CTA-dedicated protocol followed by 3D-reconstructions were performed. Identification, branching pattern, and caliber at origin were assessed for each perforator. Intraoperative findings were the standard of reference. The sensitivity, positive predictive value, and diagnostic accuracy of the preoperative CTA protocol were calculated. Results In 255/263 (97%) patients, the dominant perforators assessed by CTA resulted adequate for surgical reconstruction. In 260/263 (99%) cases, the imaging localization of the dominant perforators corresponded with those seen intraoperatively (mean errors ≤1 cm). The preoperative CTA imaging sensitivity, positive predictive value, and diagnostic accuracy in determining the localization of perforators were 99% (95% CI 98–100), 100% and 99% (95% CI 98–100), respectively. No statistically significant differences were found between the CTA findings and the surgical findings for the assessment of branching pattern and caliber of the dominant perforators ( P < 0.001). Conclusion The present protocol has demonstrated high accuracy in the CTA imaging assessment of the perforators before DIEP flap reconstruction with high reproducibility between CT and surgical findings.

Inclusion of Mesh in Donor-Site Repair of Free TRAM and Muscle-Sparing Free TRAM Flaps Yields Rates of Abdominal Complications Comparable to Those of DIEP Flap Reconstruction

2010 ◽  
Vol 126 (2) ◽  
pp. 367-374 ◽  
Author(s):  
Derrick C. Wan ◽  
Charles Y. Tseng ◽  
John Anderson-Dam ◽  
Andrew L. Dalio ◽  
Christopher A. Crisera ◽  
...  
Keyword(s):  
Donor Site ◽  
Diep Flap ◽  
Flap Reconstruction ◽  
Abdominal Complications ◽  
Muscle Sparing

MR imaging demonstration of a recurrent breast cancer following deep inferior epigastric perforator (DIEP) flap reconstruction

2006 ◽  
Vol 59 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Caroline Caramella ◽  
Alain Luciani ◽  
Thu Ha Dao ◽  
Laurent Lantieri ◽  
Laurent Zelek ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mr Imaging ◽  
Recurrent Breast Cancer ◽  
Diep Flap ◽  
Flap Reconstruction ◽  
Deep Inferior Epigastric Perforator ◽  
Recurrent Breast

scholarly journals Objective photographic assessments and comparisons of immediate bilateral breast reconstruction using deep inferior epigastric perforator flaps and implants

2021 ◽  
Vol 48 (5) ◽  
pp. 473-482
Author(s):  
Hyun Ho Han ◽  
Jin Mi Choi ◽  
Jin Sup Eom
Keyword(s):  
Breast Reconstruction ◽  
Operation Time ◽  
Bilateral Mastectomy ◽  
Average Weight ◽  
Diep Flap ◽  
Flap Reconstruction ◽  
Immediate Reconstruction ◽  
Hospitalization Period ◽  
Deep Inferior Epigastric Perforator ◽  
Bilateral Reconstruction

Background The increasing number of bilateral breast cancer patients has been accompanied by a growing need for bilateral mastectomy with immediate reconstruction. However, little research has investigated the complications and aesthetic outcomes related to bilateral reconstruction. Therefore, we analyzed retrospective data comparing the outcomes of bilateral reconstruction using deep inferior epigastric perforator (DIEP) flaps or implants.Methods This study included 52 patients (24 DIEP group and 28 implant group) who underwent bilateral mastectomy with immediate reconstruction between 2010 and 2020. Patient demographics, surgical characteristics, and complications were recorded. The difference between the left and right position of the nipple-areolar complex with respect to the sternal notch point at the clavicle was measured, and breast symmetry was evaluated.Results The average weight of breasts reconstructed with DIEP flaps (417.43±152.50 g) was higher than that of breasts with implants. The hospitalization period and operation time were significantly longer in the DIEP group. Early complications were significantly more common in the implant group (36.53%) than in the DIEP group. The angles between the nipples and the horizontal line were 1.09°±0.71° and 1.75°±1.45° in the DIEP and implant groups, respectively.Conclusions Although the surgical burden is lower, breast reconstruction using implants requires greater attention with respect to implant positioning, asymmetry, and complications than DIEP flap reconstruction. DIEP flap reconstruction has a prolonged operation time and a high risk of flap failure, but yields excellent cosmetic results and does not require intensive follow-up. Patients should be consulted to determine the most suitable option for them.

scholarly journals Development of A Surgical Treatment Algorithm for Breast Reconstruction in Poland Syndrome Patients Considering Severity, Sex, and BMI

2021 ◽  
Vol 10 (19) ◽  
pp. 4515
Author(s):  
Maximilian Mahrhofer ◽  
Thomas Schoeller ◽  
Maria Casari ◽  
Kathrin Bachleitner ◽  
Laurenz Weitgasser
Keyword(s):  
Chest Wall ◽  
Free Flap ◽  
Treatment Algorithm ◽  
Poland Syndrome ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Perforator Flaps ◽  
Fat Transfer ◽  
Institutional Experience ◽  
Deep Inferior Epigastric Perforator

Introduction: Poland syndrome is a rare, challenging combination of chest wall and breast deformities for reconstructive surgeons and selecting the treatment can prove difficult. This study aims to help surgeons in choosing the best viable option for treatment by sharing our institutional experience and proposing a guiding algorithm. Methods: A retrospective analysis of all patients with Poland syndrome undergoing treatment for breast and chest wall deformities at a single institution between December 2011 and May 2020 was performed. Medical charts were reviewed to allow for a description of patient demographics, treatment modalities and complications. A treatment algorithm to aid in selecting the adequate reconstructive option based on our institutional experience was formulated. Results: A total of 22 patients (six male, 16 female) were identified who received treatment for Poland Syndrome related deformities. Nine received microsurgical free flap reconstruction (three Deep Inferior Epigastric Perforator flaps, six Transverse Myocutaneous Gracilis flaps), two received reconstruction with a local flap (two Latissimus dorsi flaps), nine received implant based reconstruction, and two were treated with autologous free fat transfer only (17 in combination with other surgical methods). Conclusion: Free flap reconstruction with the TMG flap is a valid option for patients with low Body Mass Index (BMI), while Deep Inferior Epigastric Perforator flaps should be considered for patients with a higher BMI. Autologous free fat transfer proves to be a safe and efficient treatment option in mild cases of Poland syndrome for male and female patients, in combination with or without implant based reconstructive surgery. Multicentre studies should be conducted to achieve higher case numbers of this rare disease and support clinical decisions with more data.

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