DIEP and Muscle Sparing Breast Free Flap

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0075 ◽

2019 ◽

pp. 781-794

Author(s):

Maurice Y. Nahabedian

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site ◽

The Other ◽

No Donor ◽

Technical Aspects ◽

Body Habitus ◽

Deep Inferior Epigastric Perforator ◽

Muscle Sparing

The deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flaps are arguably the most common flaps used for autologous breast reconstruction. The benefit of these flaps is that very little to no donor site muscle is harvested. The decision to use one or the other is occasionally made preoperatively based on body habitus but often intraoperatively based on the quality of the perforating vessels. The technical aspects of the operation are similar except for the actual dissection around the perforating vessels. Studies have demonstrated no significant differences in outcome when comparing the DIEP and MS free TRAM flaps.

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Alternative flaps for microsurgical breast reconstruction

10.1093/med/9780199682874.003.0093 ◽

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.

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Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction

Scandinavian Journal of Surgery ◽

10.1177/1457496913512829 ◽

2014 ◽

Vol 103 (4) ◽

pp. 249-255 ◽

Cited By ~ 6

Author(s):

H. C. Benditte-Klepetko ◽

F. Lutgendorff ◽

T. Kästenbauer ◽

M. Deutinger ◽

C. M. A. M. van der Horst

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Deep Inferior Epigastric Perforator ◽

Types Of Breast Reconstruction

Background and Aims: Breast reconstruction has been shown to improve quality of life. However, factors involved in long-term patient satisfaction are largely unknown. Our aim was to evaluate patient satisfaction and donor-site morbidity in five types of breast reconstruction. Material and Methods: A prospectively collected database of all breast surgery patients at Hospital Rudolfstiftung, Vienna, Austria, was searched for five types of breast reconstruction (2000–2006): implant, latissimus dorsi-flap, latissimus dorsi-flap with implant, free transverse rectus abdominis musculocutaneous-flap, and deep inferior epigastric perforator-flap. Patients were sent a study-specific questionnaire to assess satisfaction. Short-form 36-item health survey was used to analyze (quality of life), and complication data were retrieved from the database and assessed during a follow-up visit. Results: There were 257 patients identified, of whom, 126 responded to the survey (17 implant, 5 latissimus dorsi + implant, 64 latissimus dorsi, 22 transverse rectus abdominis musculocutaneous, and 18 deep inferior epigastric perforator reconstructions). No statistical differences were found in complication or reoperation rates. Deep inferior epigastric perforator–flap patients were significantly more satisfied compared to patients from the implant group ( p = 0.007). However, there was no significant difference regarding quality of life scores among the groups. After logistic regression analysis, only “impairment on daily life” showed to be independently correlated with patient satisfaction. This contrary to both operation type and complication rate which did not correlate with patient satisfaction. Conclusions: Our results indicate that operation type, complication rate, and revision rate did not independently correlate with patient satisfaction. Therefore, to further improve patient satisfaction, future research should be focused on other pro-operative factors, for example, patient education, expectations, and personality characteristics.

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Free Tissue Breast Reconstruction

Seminars in Plastic Surgery ◽

10.1055/s-0039-1677703 ◽

2019 ◽

Vol 33 (01) ◽

pp. 059-066 ◽

Cited By ~ 3

Author(s):

Rami Dibbs ◽

Jeff Trost ◽

Valerie DeGregorio ◽

Shayan Izaddoost

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site ◽

Perforator Flap ◽

Free Tissue Transfer ◽

Donor Site Morbidity ◽

Fat Grafting ◽

Microsurgical Technique ◽

Deep Inferior Epigastric Perforator ◽

Aesthetic Breast

AbstractFree tissue transfer serves as a modern workhorse for breast reconstruction. Advancements in microsurgical technique have allowed for the development of free flap procedures that produce an aesthetic breast while minimizing donor site morbidity. Here, the authors review the use of different free flap procedures for breast reconstruction with a focus on the preferred and most commonly used flap, the deep inferior epigastric perforator flap. Each flap has its advantages and drawbacks, and certain patient risk factors increase postoperative complications. Other techniques of breast reconstruction including pedicled flaps and adjunctive fat grafting are also briefly discussed.

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