Bilateral Autogenous Breast Reconstruction Using Perforator Free Flaps: A Single Center???s Experience

Abstract

The authors present a single center's experience in bilateral breast reconstruction using perforator free flaps. The aim of this study was to show their indications, surgical technique, and results. A series of 53 patients underwent this procedure between February of 1996 and October of 2002. The surgical procedures were performed on patients with bilateral breast cancer (11 patients), patients with unilateral breast cancer and contralateral prophylactic mastectomy (22 patients), patients who had undergone bilateral prophylactic mastectomy (18 patients), a patient with Poland's syndrome, and a patient whose aesthetic breast augmentation had failed. Primary and secondary bilateral breast reconstructions were done in 18 and four patients, respectively. Eighteen patients who had earlier undergone breast reconstruction with implants had a tertiary breast reconstruction. Combined reconstruction (primary with secondary and primary with tertiary reconstruction) was done in 13 patients. Ninety-eight deep inferior epigastric perforator flaps and eight superior gluteal artery perforator flaps were used. The average operative time was 10 hours (range, 8 to 14.5 hours) for the simultaneous bilateral reconstruction. Total flap necrosis occurred in two cases (one deep inferior epigastric perforator flap and one superior gluteal artery perforator flap). Partial flap necrosis was not encountered, and fat necrosis was found in one deep inferior epigastric perforator flap (1 percent). Two pulmonary infections, one deep vein thrombosis, and one cardiac arrhythmia occurred as postoperative complications. The mean hospital stay was 9 days (range, 6 to 20 days). Abdominal bulging was reported in one patient. There were no recurrent disease or cancer manifestations, with an average follow-up of 3.5 years. This series clearly shows that perforator flaps are reliable and useful tools for bilateral breast reconstruction. This technique decreases the donor-site morbidity and offers an excellent aesthetic and long-term outcome and high patient satisfaction.

Bilateral simultaneous breast reconstruction with SGAP flaps

“…Other authors 15,16 report that they prefer the two-stage approach, that is, they reconstruct one breast and a few months thereafter they operate on the other; however, in our opinion, simultaneous completion of both breast reconstructions is the optimum approach for the patient who is willing to tolerate the potential added operative time and potential risk of having both flaps ischemic simultaneously. Of course, doing so requires the added resources of two microsurgeons both of whom have experience with SGAP flap harvest, and we realized that these resources are not always available at every institution; in this respect, our study may not be fully generalizable.…”

“…Several series have investigated outcomes of bilateral breast reconstructions with free flaps, and most of those surgeries have used the abdomen as the donor site. 6,12,[14][15][16]19,20 Other attractive options for bilateral breast reconstruction are implants and expanders, because of the simplicity of the operative technique and the lower operative times. Autologous tissue, however, may provide a more naturalappearing, long-lasting outcome.…”

“…Previously reported series have also shown very high success rates of 92.3%, 11 97%, 15 and 98%. 12 Reported success rates for breast reconstruction with the use of DIEP flaps are also high: 99% 16 and 100%. 14 Comparing our results with those in the literature was not always possible, because of the inadequate statistical parameters provided by some studies (Table 4).…”

Aesthetic restoration of Poland's syndrome in a male patient using free anterolateral thigh perforator flap as autologous filler

“…10,16 The use of a perforator flap is very attractive since it is associated with minimal donor site morbidity. This could be particularly useful in male manual workers, and patients involved in sporting activities.…”

Consensus and Controversy in Breast Reconstruction a Review of Current Opinion and Practice

“…A lower abdominal flap based on the deep inferior epigastric artery and vein without taking the rectus abdominis muscle was described in 1989 (102), and the DIEP flap has become established as a preferred reconstructive option (103) being used, together with other flaps such as the superior gluteal artery perforator flap (S-GAP) for bilateral reconstruction (104).…”