Bilateral Breast Reconstruction

Abstract

Not all patients seeking autogenous breast reconstruction have sufficient donor tissue for a bilateral reconstruction. Identical twin isotransplantation, as a model system for allotransplantation without immunologic barriers, broadens the definition of "spare parts" surgery. In this case, we demonstrate the simultaneous transplantation of both autogenous and syngeneic deep inferior epigastric perforator flaps for bilateral breast reconstruction. As our understanding of immunology evolves, allotransplantation may further increase our reconstructive options for other postmastectomy patients.

DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review

“…14 15 16 17 18 19 20 21 22 Compared to isogeneic solid organ transplants (SOTs), isogeneic soft tissue transplants are less frequently performed. Flap transplantation between monozygotic twins has been used for reconstruction of scalp, breast, and thoracic defects 2 3 4 5 6 7 8 ( Table 1 ). This is the fifth reported case of DIEP flap transfer for breast reconstruction in monozygotic twins, and the first to describe transplanting a bipedicled flap to reconstruct a unilateral breast.…”

“…This is the fifth reported case of DIEP flap transfer for breast reconstruction in monozygotic twins, and the first to describe transplanting a bipedicled flap to reconstruct a unilateral breast. 2 3 From an allogenic standpoint, myocutaneous flaps behave like vascularized composite allotransplants than SOTs; however, in the case of isogeneic transplant, immunosuppression is not needed. 23 Among the previously published flap transplantation cases, only one of the authors reported utilizing immunosuppression (1 month of short steroid taper) as recommended by their hospital's transplant service.…”

“…2 and 3) was designed based on studies examining SOT between twins as well as those studying soft tissue transplantation. [2][3][4][5][6]14,16,17 The first step is identifying that the twins are monozygotic. This is done by performing comparative DNA sequencing-in our patient, this was performed at 21 STRs from buccal samples.…”

“…These limitations may be avoided in monozygotic twins since they share nearly identical genetic code, not requiring lifelong immunosuppression. [1][2] Due to relatively low incidence of monozygotic twins (one in 250 births) and rarity of scenarios needing tissue transfer between individuals, only a scarce number of flap transplantations have been reported (2,3,4,5,6,7,8) . These include cases of breast, scalp, and thoracic reconstruction where patients' autologous tissues were not available or were insufficient.…”

“…1,2 Due to relatively low incidence of monozygotic twins (1 in 250 births) and rarity of scenarios needing tissue transfer between individuals, only a scarce number of flap transplantations have been reported. [2][3][4][5][6][7][8] These include cases of breast, scalp, and thoracic reconstruction where patients' autologous tissues were not available or were insufficient.…”