Stacked Lateral Thigh Perforator Flap as a Novel Option for Autologous Breast Reconstruction

Abstract

Background: Autologous breast reconstruction using perforator flaps offers excellent outcomes, minimizes donor-site morbidity, and allows for precise donor-site selection. The deep inferior epigastric artery perforator, profunda artery perforator, and gluteal artery perforator flaps along with the stacked flap technique are the most common options. This study reports the first series of the stacked lateral thigh perforator flap. Methods: A retrospective review of all stacked lateral thigh perforator flaps done by a single group of surgeons was performed. Demographics, flap weights, complications, indications, and surgical technique were tabulated for each patient. Results: Eight female patients with a history of breast cancer underwent delayed unilateral breast reconstruction with stacked lateral thigh perforator flaps for a total of 16 flaps. Mean patient age, body mass index, flap weight, and stacked flap weight were 47.3 years, 26.2 kg/m2, 333.1 g, and 666.1 g, respectively. Microsurgical revascularization was completed in anterograde and retrograde fashion to the internal mammary vasculature. Flap survival was 100 percent and one subsequent flap revision was performed. Two patients developed a seroma at the donor site. Indications included insufficient abdominal tissue, prominent lateral thigh lipodystrophy, prior abdominal surgery, and failed prior abdominally based autologous reconstruction. Conclusions: This series demonstrates that the lateral thigh perforator flap is a reliable and effective option for a stacked breast reconstruction. Its ease of harvest (stemming from reliable anatomy), straightforward dissection, and intraoperative positioning make it an appealing flap option. The stacked lateral thigh perforator flap allows the reconstructive surgeon to tailor breast reconstruction to the patient, focusing on body habitus and minimizing morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study

“…Whenever the abdomen is not a suitable donor site, the LTP flap can be harvested from the lateral thigh [ 52 , 53 ]. Compared to women who underwent IBR, women who underwent an LTP reconstruction scored moderately to significantly lower on all body-related scales.…”

A Systematic Review and Meta-Analysis of Microvascular Stacked and Conjoined-Flap Breast Reconstruction

“…SC flaps have evolved to encompass a variety of different refined techniques with multiple donor site and recipient vessel combinations. 14,16,18,20,24 Much of the literature on SC flaps, however, has consisted of smaller series from high-volume microvascular centers. The current landscape of evidence therefore strongly suggests a need for a global appraisal and rigorous evaluation of the available evidence to better draw conclusions on trends, safety and outcomes.…”

“…Definitions included clinical exam and size estimation, 5,12,13,15,17,23,26,46 imaging, 11 need for surgical excision, 8,18,19 and undefined parameters. 7,16,20,22,47 These factors must be standardized and controlled to properly evaluate risk associations.…”

“…The addition of another vascular pedicle or flap is particularly useful in patients who have a discrepancy between desired breast size and the availability of donor tissue, as well as in those in which the abdominal donor site is compromised 9 or unusable. 10 Multiple variations in SC flaps in breast reconstruction have been reported including bipedicled flaps from the abdomen, 8,[11][12][13] stacked flaps from the abdomen, 14,15 stacked flaps from the medial and lateral thighs, 10,16,17 a combination of thigh and abdominal flaps, 18,19 and even tripedicled flaps to utilize the abdomen and flanks. 20 The majority of studies on these flaps, however, consist of smaller retrospective series from single institutions.…”

Estimation of Profunda Artery Perforator Flap Weight Using Preoperative Computed Tomography Angiography

“…6,7 To surmount this potential shortcoming and better match native breast size, multiple PAP flaps may be inset in a stacked fashion. 8,9 In select patients, the relative paucity of posterior thigh tissue in relation to the amount of tissue necessary to achieve a symmetric breast reconstruction may tip the scales toward a multiflap reconstruction. It is for this reason that arriving at an accurate estimation of flap weight preoperatively is of paramount importance in surgical planning.…”