title: The use of a deep inferior epigastric perforator flap (DIEP) in a case of severe breast asymmetry secondary to radiation therapy during childhood.
abstract: Breast radiotherapy during childhood may cause unpredictable outcomes in soft tissue growth and may be responsible for most iatrogenic-related breast hypoplasias. Poor local skin quality and subcutaneous atrophy poses a difficult problem for the use of alloplastic tissues. Clinical use of a deep inferior epigastric perforator flap (DIEP) in oncological breast surgery is a common practice; however few studies have described its application in benign situations and no previous report addressed this subject. The authors indicate the use of the DIEP flap to correct severe hypomastia after previous childhood radiotherapy for hemangioma treatment, followed by unsuccessful alloplastic tissue reconstruction. For selected patients the DIEP flap may constitute a new alternative for complications of radiotherapy treatment due to the possibility of large tissue transfer with minimal donor area morbidity. The quantity of flap tissue necessary to restore the breast mound, the perforator vessel size, and the quality of suitable recipient vessels should be carefully evaluated. However, the need for microsurgical training as well as the extended surgical time are the main limiting factors for the use of this flap.
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.forename: Gustavo G
authors.initials: GG
authors.lastname: Duarte
authors.forename: Klaus
authors.initials: K
authors.lastname: Fells
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arruda
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.forename: Claudia
authors.initials: C
authors.lastname: Aldrighi
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Aldrighi
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery*; D001943:Breast Neoplasms / Q000532:radiotherapy; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D006391:Hemangioma / Q000532:radiotherapy; D006801:Humans; D016462:Mammaplasty; D011878:Radiotherapy / Q000009:adverse effects*; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation; D012720:Severity of Illness Index; D013524:Surgical Flaps