Fat-Augmented Latissimus Dorsi versus Deep Inferior Epigastric Perforator Flap: Comparative Study in Delayed Autologous Breast Reconstruction

2020 ◽  
Author(s):  
Efterpi C. Demiri ◽  
Antonios Tsimponis ◽  
Anastasios Pagkalos ◽  
Eleni Georgiadou ◽  
Olga-Christina Goula ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Demographic Data ◽  
Perforator Flap ◽  
Diep Flap ◽  
Breast Volume ◽  
Autologous Breast Reconstruction ◽  
Patients Satisfaction ◽  
Delayed Breast Reconstruction ◽  
Group A ◽  
Deep Inferior Epigastric Perforator

Abstract Background The use of autologous tissues is considered the mainstay for delayed breast reconstruction. Aside the free abdominal flaps, which are most commonly used, the fat-augmented latissimus-dorsi (FALD) flap has been recently shown a reliable alternative option for pure autologous breast reconstruction. In this retrospective study, we aim to compare outcomes of autologous breast reconstructions using the extended FALD and deep inferior epigastric perforator flap (DIEP) flap, with an emphasis on patients' characteristics, demographic data, complications, and patients' satisfaction after a minimum 12-month follow-up. Methods Our series consists of 135 women who underwent a delayed postmastectomy unilateral autologous breast reconstruction from 2011 to 2017: 36 patients (Group A) had an extended FALD flap and 99 (Group B) a free DIEP flap performed by the same surgeons. Demographic data, breast volume, medical history, smoking, complications, and patients' satisfaction were recorded and analyzed. Student's t-test for independent variables, Mann–Whitney U-test, and Chi-squared test were used to compare the reported variables. Results Patients' age, body mass index (BMI), and pregnancy history were statistically different between groups (p < 0.001, p = 0.004, p < 0.001, respectively); younger age (35.1 vs. 41.2 years), lower BMI (25.6 vs. 28.4), and fewer pregnancies were recorded in Group A. Breast volume was also found significantly smaller in Group A patients (p = 0.009). Past medical history using the ASA physical status classification score, previous radiation therapy, history of smoking, and incidence of overall complications were similar in both groups. Overall satisfaction scores were found slightly higher, but not statistically significant, in the free-flap group (p = 0.442). Conclusion The use of the FALD flap may provide comparable outcome to the DIEP flap in delayed breast reconstruction in terms of complications and patients' satisfaction; it should be considered a good reconstructive option for young and thin nulliparous patients, with small to medium size opposite breast.

scholarly journals Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989883
Author(s):  
Trina V. Stephens ◽  
Nancy Van Laeken ◽  
Sheina A. Macadam
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
First Line ◽  
Percutaneous Aspiration ◽  
Autologous Breast Reconstruction ◽  
History Of ◽  
Deep Inferior Epigastric Perforator ◽  
Latissimus Dorsi Flaps

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.

Alternative flaps for microsurgical breast reconstruction

2021 ◽  
pp. 1107-1114
Author(s):  
Hinne A. Rakhorst
Keyword(s):  
Breast Reconstruction ◽  
Standard Care ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
The Body ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Muscle Sparing ◽  
Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

Unilateral Autologous Breast Reconstruction with Bi-pedicled, Conjoined Deep Inferior Epigastric Perforator Flaps

2018 ◽  
Vol 35 (02) ◽  
pp. 145-155 ◽  
Author(s):  
Akhil Seth ◽  
Pieter Koolen ◽  
Steven Sultan ◽  
Bernard Lee ◽  
Heather Erhard ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Side Branch ◽  
Diep Flap ◽  
Autologous Breast Reconstruction ◽  
Pedicled Flaps ◽  
Skin Envelope ◽  
The Status ◽  
Deep Inferior Epigastric Perforator

Background The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and “footprint.” This study summarizes our experience with using bipedicled DIEP flaps to improve the aesthetic results of unilateral breast reconstruction in such patients. Methods Consecutive patients undergoing unilateral breast reconstruction with bi-pedicled, conjoined DIEP flaps over a 4-year period were retrospectively reviewed. Primary and secondary flap microvascular anastomoses were performed to the antegrade internal mammary (IM) vessels and to either the retrograde IM vessels or a primary DIEP pedicle side branch, respectively. Clinical characteristics and outcomes were recorded. Results Sixty-three patients underwent immediate (n = 29) or delayed (n = 34) reconstruction, with age and body mass index of 54.1 ± 8.4 years and 26.6 ± 4.7, respectively. Mean follow-up was 14.1 months. Twenty-eight (44.4%) patients received prereconstruction radiation therapy. All patients had preoperative abdominal imaging, including 57 (90.5%) using magnetic resonance angiography. There were no flap losses with three operative interventions for flap salvage. Conclusion Unilateral breast reconstruction with bipedicled, conjoined DIEP flaps is safe and reliable. These procedures can be performed with a complication profile similar to single-pedicle DIEP flaps. The additional skin and soft tissue available with bi-pedicled flaps allows for greater flexibility in matching the shape and projection of a woman's contralateral breast, and in some cases is necessary to achieve an aesthetically acceptable reconstruction. With growing expectations among breast reconstruction patients, conjoined bi-pedicled flaps represent a tool for meeting their reconstructive needs and exceeding the status quo for aesthetic outcomes.

scholarly journals Economic Analysis of Noninvasive Tissue Oximetry for Postoperative Monitoring of Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Review

2020 ◽  
pp. 155335062094298
Author(s):  
Anouk A. M. A. Lindelauf ◽  
Nousjka P. A. Vranken ◽  
Vivian G. H. Rutjens ◽  
Rutger M. Schols ◽  
John H. Heijmans ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Breast Reconstruction ◽  
Postoperative Care ◽  
Hospital Costs ◽  
Perforator Flap ◽  
Diep Flap ◽  
Postoperative Monitoring ◽  
Reconstruction Methods ◽  
Deep Inferior Epigastric Perforator ◽  
Tissue Oximetry

Background. Postoperative monitoring of deep inferior epigastric perforator (DIEP) flaps for breast reconstruction using noninvasive tissue oximetry enables timely recognition of vascular compromise. This may limit ischemic tissue damage, minimizing postoperative morbidity and healthcare costs. The aim of this review was to provide an economic analysis of tissue oximetry for postoperative monitoring of DIEP flap breast reconstruction. Methods. A systematic literature search was conducted utilizing PubMed and Embase. Articles reporting costs related to tissue oximetry following DIEP flap breast reconstruction, costs directly related to DIEP flap surgical procedure, and costs associated with postoperative complications were included. Risk of bias was assessed using different tools depending on study type. Results. Six articles were included. Four studies provided an overview of total costs associated with DIEP flap breast reconstruction; two studies focused on whether tissue oximetry could facilitate a decrease in hospital costs. Average overall costs for DIEP flap procedure were estimated at $28 000, with additional costs up to $37 530 in case of total flap failure. Tissue oximetry to monitor DIEP flaps could potentially save up to $1667 per procedure. Moreover, it might eliminate the need for specialized postoperative care. Conclusion. Tissue oximetry following DIEP flap breast reconstruction can potentially facilitate a decrease in hospital costs since its readings enable physicians to intervene in an early stage of tissue malperfusion, contributing to minimizing complications. Tissue oximetry may eliminate the need for specialized postoperative care. However, based on the current literature, no firm conclusions can yet be drawn regarding cost-effectiveness of standard implementation.

scholarly journals Aesthetical outcome after breast reconstruction using deep inferior epigastric perforator flap: Personal techniques

2013 ◽  
Vol 46 (03) ◽  
pp. 513-517 ◽  
Author(s):  
Chiara Gelati ◽  
Luca Negosanti ◽  
Erich Fabbri ◽  
Riccardo Cipriani
Keyword(s):  
Breast Reconstruction ◽  
Perforator Flap ◽  
Diep Flap ◽  
Breast Asymmetry ◽  
Inferior Pole ◽  
The World ◽  
Deep Inferior Epigastric Perforator ◽  
Reconstructed Breast

ABSTRACT Background: Now-a-days, deep inferior epigastric perforator (DIEP) flap breast reconstruction is widespread throughout the world. The aesthetical result is very important in breast reconstruction and its improvement is mandatory for plastic surgeons. Materials and Methods: The most frequent problems, we have observed in breast reconstruction with DIEP flap are breast asymmetry in terms of volume and shape, the bulkiness of the inferior lateral quadrant of the new breast, the loss of volume of the upper pole and the lack of projection of the inferior pole. We proposed our personal techniques to improve the aesthetical result in DIEP flap breast reconstruction. Our experience consists of more than 220 DIEP flap breast reconstructions. Results: The methods mentioned for improving the aesthetics of the reconstructed breast reported good results in all cases. Conclusion: The aim of our work is to describe our personal techniques in order to correct the mentioned problems and improve the final aesthetical outcome in DIEP flap breast reconstruction.

scholarly journals The Deep Inferior Epigastric Perforator (DIEP) Flaps in Breast Reconstruction After Mastectomy

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Dyandra Parikesit ◽  
Mark Ashton
Keyword(s):  
Breast Reconstruction ◽  
Current Knowledge ◽  
Subcutaneous Fat ◽  
Diep Flap ◽  
Tram Flap ◽  
Complication Rates ◽  
Autologous Breast Reconstruction ◽  
Patient Satisfaction Score ◽  
Aesthetic Appearance ◽  
Deep Inferior Epigastric Perforator

Background: The continuing advances in breast reconstruction surgery allows for high expectation of excellent outcomes and long-term aesthetic appearance. Transverse rectus abdominis muscle (TRAM) flap has been the flap of choice in breast reconstructions for decades, however it sacrifices muscle and causes donor site complication. Deep inferior epigastric perforator (DIEP) flap is now the preferred flap for microsurgical breast reconstruction, because it holds some advantages over TRAM. This study aim to review, summarize, and discuss the current knowledge of DIEP flap in breast reconstruction.Method: Literature research conducted through Pubmed, Medline, and SCOPUS databases for published articles up to the year 2009. A total of 808 articles were found, and 60 articles reviewed.Result: Women with thick subcutaneous fat and skin on the lower abdomen are the most appropriate candidates for autologous breast reconstruction. Patients might be given oral analgesics instead of intravenous, because DIEP results in less postoperative pain than TRAM. Patients are commonly discharged on the 6–7th day post operation after DIEP flaps. In spite of several reports that DIEP flap has low complication rates, necrosis is the most common and often leads to poor cosmetic outcome.Conclusion: DIEP flap essentially combines all the advantages of TRAM flap without most of its disadvantages. Some complications may occur in smaller percentage. Although DIEP flap has a high patient satisfaction score, it does not mean that it is definitely superior to other methods of autologous breast reconstruction.

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