Mammary Reconstruction with Bipedicled Abdominal Flap

Marino, Héctor; Dogliotti, Pedro

doi:10.1097/00006534-198112000-00016

Cited by 13 publications

(1 citation statement)

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“…However, by raising bipedicled flaps or stacked free flaps more tissue is incorporated in the free flaps and this makes it possible to reconstruct a breast entirely with autologous tissue in this patient group ( 11 ). The use of conjoined DIEP flaps is the most common method in multiple free flap breast reconstructions ( 28 - 30 ). The technique of raising the entire lower abdomen based on two vascular pedicles was initially outlined by Arnez and his team in 1992, where they implemented it with the bipedicled free TRAM flap ( 31 ).…”

Section: Stacked/combined Flapsmentioning

confidence: 99%

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Chakari,

Bille,

Lilja

et al. 2024

Gland Surg

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Background and Objective Perforator flaps have revolutionized autologous breast reconstruction, introducing both free and pedicled options as well as the potential for combining flaps. These versatile techniques can be utilized in massive weight loss (MWL) patients, effectively addressing both functional and aesthetic challenges by using their excess skin. This review aims to explore literature on combined pedicled and free perforator flaps for total breast reconstruction, and share our own experience in the field. Methods A PubMed search up to June 2023 employed Medical Subject Headings (MeSH) terms such as ((“combined”) OR (“stacked”) OR (“conjoined”) AND (“perforator flaps”)) AND (“breast reconstruction”). Publications in English and Scandinavian languages were manually screened for relevance, and supplemental sources were also reviewed. Key Content and Findings Limited studies exist on using combined pedicled and free flaps for total breast reconstruction, although combined free flaps are more common. Perforators around the breast base, offer multiple flap options for single or combined use. In our series of 10 women, four underwent total breast reconstruction with a combination of flip-over internal mammary artery perforator (IMAP) flap and thoracodorsal artery perforator (TDAP) flap. Another subset of four, who were MWL patients, received combined TDAP and superior epigastric artery perforator (SEAP) flaps, along with body contouring procedures such as upper body lifts and vertical abdominoplasties, addressing excess skin and improving silhouette. One remaining MWL patient had deflated breasts restored using TDAP and SEAP flaps, along with an upper and lower body lift and vertical abdominoplasty. The last MWL patient underwent a risk-reducing mastectomy, also reconstructed with TDAP and SEAP flaps, and received an upper body lift and vertical abdominoplasty Conclusions Combined perforator flap techniques for combined body contouring and breast reconstruction seems safe and especially suitable for MWL patients. They offer a surgical alternative merging body contouring and breast reconstruction in cases where free flap procedures seem less favorable due to skin laxity and deflation of donor sites. However, limited literature on the topic calls for further studies.

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Section: Stacked/combined Flapsmentioning

confidence: 99%

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Chakari,

Bille,

Lilja

et al. 2024

Gland Surg

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Internal mammary artery and vein supercharge in tram flap breast reconstruction

1996

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To improve the blood supply of the pedicled flap we have performed an additional microvascular augmentation to this type of breast reconstruction procedure since 1991. The ipsilateral deep inferior epigastric pedicle is anastomosed to the internal mammary artery and vein (IMAV supercharge). In 19 of 20 patients this technique proved to be feasible. For the venous anastomoses the 3M microvascular anastomosis system facilitated the procedure. In one patient the venous anastomosis failed due to the small calibre of two internal mammary veins. In a majority of the cases rapid improvement of flap perfusion could be observed as the direct result of the supercharging. The IMAV supercharged flap is quite comparable with the free flap as regards to the operative procedure. Disadvantages are a slightly more extensive dissection and less freedom in positioning the flap due to the presence of the superior muscular pedicle. The main advantage is that the supercharge procedure minimises the risk of total flap loss. Further technical improvement may be obtained by the use of a contralateral vascular pedicle dissected with muscle-sparing techniques.

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A Complete History of Breast Reconstruction

Champaneria

2016

Breast Reconstruction

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Mammary Reconstruction with Bipedicled Abdominal Flap

Cited by 13 publications

References 0 publications

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Internal mammary artery and vein supercharge in tram flap breast reconstruction

A Complete History of Breast Reconstruction

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