The Fleur-de-lis DIEP-Introducing a 5th zone for DIEP reconstruction

Salim, Faisal; Adlard, R.

doi:10.1016/j.bjps.2013.01.003

Cited by 5 publications

(14 citation statements)

References 5 publications

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“…The patient required 1 revision surgery to reduce the size of the reconstructed breast. Ultimately, the patient achieved a successful reconstruction with an acceptable breast size and shape, allowing the authors to describe the fleur-de-lis DIEP as a solution for enhancing abdominal contour while attaining reconstruction after MWL 24 . Wechselberger et al 25 reported a case of bilateral DIEP flap breast reconstruction after MWL, which yielded an aesthetically pleasing result in the breasts with the added benefit of excision of excess abdominal tissue, which had created an “apron” appearance after MWL.…”

Section: Resultsmentioning

confidence: 99%

“…Based on the reviewed articles, abdominally based flap reconstruction is a safe option for MWL women requiring breast reconstruction and provides an aesthetically acceptable result that can be associated with high levels of patient satisfaction. [16][17][18][20][21][22][23][24][25] In addition to a successful breast reconstruction, abdominally based flaps can also contribute to a favorable abdominal contour with removal of excess tissue resulting from MWL. 20 Based on results, it is safe to delay an autologous breast reconstruction with abdominally based flaps to undergo bariatric surgery and return for breast reconstruction after MWL is achieved.…”

Section: Microvascular Reconstructionmentioning

confidence: 99%

“…The authors used this technique because of the lack of volume available in the subumbilical area and resulting need to use epigastric tissue to provide additional volume and projection to the reconstructed breast. 24 Computed tomography angiography was used preoperatively to ensure perforator availability. Postoperatively, there were no complications with the reconstructed breast, but the abdominal site required reinsertion of a drain to manage a seroma.…”

Section: Microvascular Reconstructionmentioning

confidence: 99%

“…Postoperatively, there were no complications with the reconstructed breast, but the abdominal site required reinsertion of a drain to manage a seroma. 24 The patient required 1 revision surgery to reduce the size of the reconstructed breast. Ultimately, the patient achieved a successful reconstruction with an acceptable breast size and shape, allowing the authors to describe the fleur-de-lis DIEP as a solution for enhancing abdominal contour while attaining reconstruction after MWL.…”

Section: Microvascular Reconstructionmentioning

confidence: 99%

See 3 more Smart Citations

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients

Sinik¹,

Egan²,

Patel³

et al. 2021

Ann Plast Surg

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Given global trends in obesity and bariatric surgeries, there are an increasing number of women presenting for breast reconstruction after massive weight loss. There is a paucity of literature about breast reconstruction after mastectomy in patients with a history of massive weight loss. A literature review revealed 10 articles that discussed outcomes of different reconstruction techniques in patients with massive weight loss. Autologous reconstruction techniques and implant-based reconstruction techniques were assessed to evaluate the advantages, disadvantages, and indications of each approach specific to this unique patient population. This article provides a summary of expected outcomes, including complication profiles. Ultimately, consideration should be given for breast reconstruction of mastectomy defects in patients with a history of massive weight loss, as satisfactory results are demonstrated to be possible. Both autologous reconstruction and implant-based reconstruction present feasible options, although reconstruction in this patient population may be associated with increased need for revisions and a higher complication rate compared with patients without a history of massive weight loss. For this reason, it is imperative to appropriately manage preoperative expectations in patients with a history of massive weight loss.

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Section: Resultsmentioning

confidence: 99%

Section: Microvascular Reconstructionmentioning

confidence: 99%

Section: Microvascular Reconstructionmentioning

confidence: 99%

Section: Microvascular Reconstructionmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients

Sinik¹,

Egan²,

Patel³

et al. 2021

Ann Plast Surg

View full text Add to dashboard Cite

show abstract

“…8 There is a paucity of literature regarding breast reconstruction in patients who have experienced MWL, but existing data suggest that these patients may require more revisions to achieve an aesthetically acceptable result when compared with patients without a history of MWL. 2,[9][10][11][12][13] Previous studies published on autologous breast reconstruction in patients with a history of MWL have helped illuminate some trends and unique considerations in this specific population, but reported sample sizes have been small. This limited evidence indicates that further exploration into this population is required to make evidencebased recommendations for care.…”

mentioning

confidence: 99%

Autologous Breast Reconstruction in Massive Weight Loss Patients: Understanding Risks in a Growing Population

Sinik

Elver

Egan

et al. 2023

Plastic &Amp; Reconstructive Surgery

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strong correlation exists between obesity and breast cancer risk. 1 Obesity has also been shown to increase complications in abdominally based autologous breast reconstruction, leading to a denial of procedures for patients with obesity. 2,3 This concern for increased complications in patients with obesity may prompt clinicians to suggest bariatric surgery as a strategy to help these patients achieve weight loss in anticipation of breast reconstruction. 2,4 Given this Background: Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rising rates of obesity and bariatric surgery, more patients who have experienced MWL will be presenting for breast reconstruction. The authors hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared with reconstruction in patients without a history of MWL. Methods: A retrospective review was performed on patients who underwent autologous breast reconstruction by five microsurgeons at an academic institution from 2009 through 2020. Patients with a history of bariatric surgery or greater than 50-pound weight loss were identified and compared with patients who had not experienced MWL. Analysis compared demographics, operative details, complications, revision rates, and BREAST-Q scores. Results: Of 916 patients who underwent 1465 flaps, 39 patients with MWL (4.3%) underwent 68 flaps (4.6%), and 877 patients without MWL underwent 1397 flaps. MWL patients were more likely to require blood transfusions postoperatively (P = 0.005); experienced more surgical-site infections (P = 0.02), wound-healing complications of flap (P = 0.007) and donor sites (P = 0.03), and late partial flap losses (P = 0.03); and required more revisional surgery for flap (P = 0.009) and donor sites (P = 0.01). BREAST-Q scores were not statistically different for satisfaction with breasts or surgeon but were lower in MWL patients for psychosocial (P = 0.01) and sexual well-being (P = 0.04). Conclusions: Reconstructive surgeons should expect increased postoperative complications when performing autologous breast reconstruction in patients who have experienced MWL. These patients should be counseled on the possibility of an increased risk of postoperative complications and need for revisional surgery.

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Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction

Bourn

Torabi

Stalder

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Summary: Perforator-free flaps, in autologous breast reconstruction, have expanded to exploit tissue available at smaller donor sites while retaining high success and low risk rates. Abdominal based flaps, such as the deep inferior epigastric perforator, remain the most common; however, when the abdomen is not an appropriate donor site, lower extremity flaps are options. The profunda artery perforator has the benefit of hiding unsightly scar in the gluteal crease but has the drawback of poor donor site volume. Our mosaic fleur-de-profunda artery perforator flap technique for breast reconstruction has shown to increase volume with the addition of a vertical limb, include full angiosome of perforators, and exhibit donor site morbidity equivalent to a medial thigh lift.

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The Fleur-de-lis DIEP-Introducing a 5th zone for DIEP reconstruction

Cited by 5 publications

References 5 publications

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients

Autologous Breast Reconstruction in Massive Weight Loss Patients: Understanding Risks in a Growing Population

Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction

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