Invited Response on: Breast Reconstruction with SIEA Flaps: An Alternative in Selected Cases

Grünherz, Lisanne; Wolter, A; Andree, Christoph; Thamm, Oliver C.

doi:10.1007/s00266-020-01640-2

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Autologous tissue can be used for repair, and the most frequently used donor sites for autologous tissue for reconstruction are on the abdomen, including transverse rectus abdominis myocutaneous flaps, 6 deep inferior epigastric perforator flaps, 7 and superficial inferior epigastric artery flaps. 8 When abdominal sites are not suitable, options can include a latissimus dorsi flap 9 or a gluteus maximus flap. 10 However, these flaps need to be transferred from a distant area to the breast and can result in donor site injuries and a long postoperative recovery time.…”

Section: Discussionmentioning

confidence: 99%

Repair of Breast Defect by Transfer of a Contralateral Internal Mammary Artery Perforator Flap

Yang¹,

Wu²,

Zhang³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: This is a case report of a patient with a borderline phyllodes tumor in the left breast. Seventeen months after the resection of the phyllodes tumor from the patient’s left breast, the tumor occurred again 5 months ago in the surgical region. A large defect was generated after the extended resection of the left breast mass, and it was repaired with a contralateral internal mammary artery perforator flap. After the operation, bilateral breast symmetry was good, and the patient was satisfied with the shape of the breast. Postoperative follow-up was performed for 15 months, and no local recurrence was observed.

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Section: Discussionmentioning

confidence: 99%

Repair of Breast Defect by Transfer of a Contralateral Internal Mammary Artery Perforator Flap

Yang¹,

Wu²,

Zhang³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Plastic surgery is often conducted on bilateral organs, which can result in clustering of data. 1–3 Clustering is when some observations within a data set are internally related and, therefore, are more similar when compared with other observations in the data set. An example is patients undergoing bilateral breast surgery.…”

mentioning

confidence: 99%

How to Report Data on Bilateral Procedures and Other Issues with Clustered Data: The CLUDA Reporting Guidelines

Hemmingsen

Nygaard

Kaufmann

et al. 2022

Plastic &Amp; Reconstructive Surgery

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lastic surgery is often conducted on bilateral organs, which can result in clustering of data. [1][2][3] Clustering is when some observations within a data set are internally related and, therefore, are more similar when compared with other observations in the data set. An example is patients undergoing bilateral breast surgery.The two breasts of one individual are related and, therefore, are expected to be more alike than the breasts of two individuals. Clustered data can be a challenge when reporting and analyzing data, which is illustrated in the following example.A hypothetical study investigates the effect of tumescence on drain output in patients undergoing breast reduction with and without the use of tumescence. First, we assume that the authors include 40 patients undergoing bilateral breast reduction. They have allocated 20 patients to be treated with tumescence and 20 patients with no tumescence. The authors of this hypothetical study can choose to report their outcomes per patient or per breast. If the authors report the outcome per patient (n = 20 in each group), they potentially lose the data that each breast contributes. Conversely, if they report data per breast

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“…Using the superficial inferior epigastric artery perforator (SIEA) flap in autologous breast reconstruction can be tempting because of its rapidity of harvest, limited abdominal morbidity, and potentially broad perforasome. 1–8 Despite its continued advocates, other centers have published extensively on the high rates of vessel size mismatch, arterial thrombosis, fat necrosis, and flap failure in SIEA flap breast reconstruction. 3,9–12 Even if a reconstructive surgeon is dedicated to never performing an SIEA flap again because of these widespread potential issues, use of the superficial system can invariably be necessary.…”

mentioning

confidence: 99%

Abandoning the SIEA flap for the “Dual-Plane” DIEP Reduces Fat Necrosis and Flap Failure

Hembd

Liu

Haddock

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Despite its limitations in abdominally based breast reconstruction, using the superficial inferior epigastric artery (SIEA) flap or system can be advantageous in specific clinical scenarios. To optimize outcomes in these cases, the authors performed a retrospective review of their flap series to advocate a new algorithm to use the superficial system. Methods: A retrospective analysis was performed on 1700 consecutive free abdominal flaps for the presence of a dominant superficial system or poor deep inferior epigastric artery perforators (DIEP) on clinical examination or angiography. In this setting, the authors analyzed the primary outcome measures of fat necrosis and flap failure with use of the superficial system alone versus a “dual-plane DIEP,” where there was an intraflap anastomosis performed between the DIEP pedicle and SIEA pedicle. A multivariable analysis was performed with 21 other potentially confounding variables and compared with outcomes with traditionally perfused DIEP flaps. Results: Fat necrosis was present in 13% of 506 DIEP flaps, 34.1% of 41 SIEA system flaps, and 2.7% of 37 dual-plane DIEP flaps. Superficial system–only flaps were independent predictors of fat necrosis (OR, 6.55; P < 0.001) and flap failure (OR, 9.82; P = 0.002) compared with dual-plane DIEP flaps when used for the same indications. Conclusion: In settings of superficial dominance or need to augment perfusion to lateral zones in abdominal free flaps, performing a dual-plane DIEP flap instead of using the superficial system vasculature alone with an SIEA flap can decrease the odds of fat necrosis and flap failure to equal that of a standard DIEP flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Invited Response on: Breast Reconstruction with SIEA Flaps: An Alternative in Selected Cases

Cited by 3 publications

References 10 publications

Repair of Breast Defect by Transfer of a Contralateral Internal Mammary Artery Perforator Flap

Repair of Breast Defect by Transfer of a Contralateral Internal Mammary Artery Perforator Flap

How to Report Data on Bilateral Procedures and Other Issues with Clustered Data: The CLUDA Reporting Guidelines

Abandoning the SIEA flap for the “Dual-Plane” DIEP Reduces Fat Necrosis and Flap Failure

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