title: Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years.
abstract: BACKGROUND
  Breast reconstruction continues to evolve. The deep inferior epigastric perforator (DIEP) flap is a well-described means of providing natural tissue reconstruction with an attendant goal of minimizing damage in the abdominal donor site.
  
  
  METHODS
  For patients with the need for autogenous reconstruction of a single breast and insufficient abdominal fatty volume for routine DIEP flap reconstruction, the authors present an option that allows for incorporation of the entire abdominal fatty composite with sequential linkage and stacked inset of two individual abdominal flaps. The ability to take advantage of the entirety of the abdominal donor volume allows those with a relatively thin body habitus to enjoy candidacy for DIEP flap reconstruction. This sophisticated microsurgical procedure overcomes some of the limitations of other techniques with similar goals such as the bipedicled transverse rectus abdominis musculocutaneous flap by avoiding muscle sacrifice and allowing precise, independent flap inset. The authors describe their experience with this technique in 55 patients with 110 flaps over 3 years.
  
  
  RESULTS
  The authors' experience reviews the use of the stacked DIEP flap in a large number of patients with high success rates and superb aesthetic outcomes over a relatively short period of time. Of the 55 patients who underwent reconstruction, all enjoyed successful outcomes. Patient satisfaction was high in the studied population.
  
  
  CONCLUSIONS
  Stacked DIEP free flap breast reconstruction is a reproducible, safe, and innovative yet technically demanding solution for patients seeking autogenous breast reconstruction with otherwise inadequate abdominal fatty volume.
authors.affiliation: New Orleans, La. From the Center for Restorative Breast Surgery.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: DellaCroce
authors.forename: Scott K
authors.initials: SK
authors.lastname: Sullivan
authors.forename: Chris
authors.initials: C
authors.lastname: Trahan
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000601:surgery*; D000328:Adult; D000368:Aged; D019074:Epigastric Arteries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome