Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients

Mani, Maria; Saour, Samer; Ramsey, Kelvin; Power, Kieran; Harris, Paul A.; James, Simon

doi:10.1002/micr.30173

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…However, our study suggests that this is not due to increased pain at the donor sites or the need for greater morphine. Our length of stay is however similar to representative UK cohorts of DIEP and other autologous tissue-based breast reconstructions which have reported mean length of stay ranging between 6.8 and 10.2 days 16 17 18 . Historically earlier discharges have been reported in North American studies with mean length of stay between 4 and 5 days 14 15 19 20 .…”

Section: Discussionsupporting

confidence: 82%

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

et al. 2020

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Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction.Methods A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression.Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001).Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

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Section: Discussionsupporting

confidence: 82%

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

et al. 2020

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“…Also, Vollbach et al outlined 13.2% non-operative complications on the medial thigh donor site [ 22 ]. In comparison, surgical site complications on the lower abdomen donor site are reported to be as high as 33% in unilateral DIEP flap breast reconstruction and 31% in bilateral DIEP flap breast reconstruction in slim to normal weight patients (BMI < 25.0 kg/m 2 ), similar to the complication rate of high-risk patients with obesity [ 23 , 24 ]. Notably, the average DIEP flap volume per breast was similar to TMG flap volume in bilateral breast reconstruction [mean 365 (78–654) g] [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

et al. 2021

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Purpose The transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction. Methods A retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts. Results Ninety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs. Conclusion The TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

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“…In total, 61 full-text articles were included for data extraction, representing a total of 24,742 free-flaps for breast reconstruction. Fourteen of the studies were PAP focused, 7,8,15–25 six were LAP focused, 12,13,26–29 and 41 were DIEP focused 2,12,15,30–66 . Of the PAP focused papers, three included outcomes from stacked PAP flaps for unilateral breast reconstruction 8,16,20 .…”

Section: Resultsmentioning

confidence: 99%

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction

Minkhorst,

Castanov,

et al. 2024

Ann Plast Surg

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Introduction Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is the current gold-standard autologous option. The profunda artery perforator (PAP) and lumbar artery perforator (LAP) flaps have more recently been described as alternatives for patients who are not candidates for a DIEP flap. The aim of this study was to review the survival and complication rates of PAP and LAP flaps, using the DIEP flap as a benchmark. Methods A literature search was conducted using PubMed, MEDLINE, Embase, BIOSIS, Web of Science, and Cochrane databases. Papers were screened by title and abstract, and full texts reviewed by three independent blinded reviewers. Quality was assessed using MINORS criteria. Results Sixty-three studies were included, for a total of 745 PAP, 62 stacked PAP, 187 LAP, and 23,748 DIEP flap breast reconstructions. The PAP (98.3%) had comparable success rate to DIEP (98.4%), and the stacked PAP (88.7%) and LAP (92.5%) success rate was significantly lower (P < 0.0001). The PAP and LAP groups both had a low incidence of fat necrosis. However, the revision rate for the LAP group was 16.1% whereas the PAP group was 3.3%. Donor site wound dehiscence rate was 2.9 in the LAP group and 9.1% in the PAP group. Conclusions Profunda artery perforator and DIEP flaps demonstrate very high rates of overall survival. The LAP flap has a lower survival rate. This review highlights the survival and complication rates of these alternative flaps, which may help clinicians in guiding autologous reconstruction technique when a DIEP flap is unavailable.

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Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients

Abstract: The DIEP flaps may be a safe option for bilateral breast reconstruction among patients with BMI <25 without sacrifice in volume or increase in donor-site complications; low BMI does not in itself contraindicate bilateral DIEP breast reconstruction.

Cited by 9 publications

References 43 publications

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction

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