title: Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions.
abstract: Perforator flap breast reconstruction is an accepted surgical option for breast cancer patients electing to restore their body image after mastectomy. Since the introduction of the deep inferior epigastric perforator flap, microsurgical techniques have evolved to support a 99 percent success rate for a variety of flaps with donor sites that include the abdomen, buttock, thigh, and trunk. Recent experience highlights the perforator flap as a proven solution for patients who have experienced failed breast implant-based reconstructions or those requiring irradiation. Current trends suggest an application of these techniques in patients previously felt to be unacceptable surgical candidates with a focus on safety, aesthetics, and increased sensitization. Future challenges include the propagation of these reconstructive techniques into the hands of future plastic surgeons with a focus on the development of septocutaneous flaps and vascularized lymph node transfers for the treatment of lymphedema.
authors.affiliation: Chicago, Ill.; Houston, Texas; New York and Bronx, N.Y.; Mt. Pleasant and Charleston, S.C.; and Metairie, La. From the Medical University of South Carolina and The Dr. Marga Practice Group; The Center for Breast Reconstruction; The Center for Microsurgical Breast Reconstruction; The Center for Natural Breast Reconstruction; private practice; Bronx Plastic Surgery; and New York University.
authors.forename: Marga F
authors.initials: MF
authors.lastname: Massey
authors.forename: Aldona J
authors.initials: AJ
authors.lastname: Spiegel
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Levine
authors.forename: James E
authors.initials: JE
authors.lastname: Craigie
authors.forename: Richard M
authors.initials: RM
authors.lastname: Kline
authors.forename: Kamran
authors.initials: K
authors.lastname: Khoobehi
authors.forename: Heather
authors.initials: H
authors.lastname: Erhard
authors.forename: David T
authors.initials: DT
authors.lastname: Greenspun
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D008408:Mastectomy; D008866:Microsurgery; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply*