Bipedicle-conjoined perforator flaps in breast reconstruction.
BACKGROUND
For some patients seeking autologous breast reconstruction, there may be insufficient abdominal skin and soft tissue to reconstruct an adequately sized breast. Perfusion from a single-pedicle deep inferior epigastric perforator artery flap has a high degree of variability across the midline, and this further limits perfusion. We have found that bipedicle-conjoined abdominal perforator flaps are a novel and reliable technique for reconstruction in these women, and this study examines our experience.


METHODS
A retrospective review was performed over a 2-y period of bipedicle-conjoined abdominal perforator flaps in 28 patients. For each reconstruction, the pedicle of one flap was anastomosed to the anterograde internal mammary artery vessels and the pedicle of the second flap to a side branch of the primary flap or the retrograde internal mammary vessels.


RESULTS
Mean age and body mass index were 50.2 y (standard deviation, 8.0) and 25.9 kg/m(2) (standard deviation, 2.8), respectively. In total, 15 patients (53.6%) received radiation therapy before surgery. There were no flap losses; fat necrosis was found in one flap (3.2%). The large contiguous skin island of the bipedicle-conjoined deep inferior epigastric perforator flaps allowed for extensive replacement of damaged or absent breast skin when necessary. Aesthetically satisfactory results were achieved in all patients.


CONCLUSIONS
Bipedicle-conjoined abdominal perforator flaps represent a novel technique in select patients seeking breast reconstruction. The added complexity was safe and reliable in this series of patients. Compared to unipedicle flaps, the increased skin and volume allow greater flexibility to achieve the desired shape and projection.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Pieter G L
PG
Koolen
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Bernard T
BT
Lee
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Samuel J
SJ
Lin
Division of Plastic and Reconstructive Surgery, Department of Surgery, Albert Einstein College of Medicine, Bronx, New York.
Heather A
HA
Erhard
Division of Plastic and Reconstructive Surgery, Department of Surgery, Greenwich Hospital, Greenwich, Connecticut. Electronic address: dgreenspun@davidgreenspunmd.com.
David T
DT
Greenspun
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001943:Breast Neoplasms / Q000601:surgery*; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D008408:Mastectomy; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply; D012189:Retrospective Studies; D016896:Treatment Outcome
Bipedicle DIEP flap; Breast cancer; Breast reconstruction; Deep inferior epigastric perforator flap; Stacked DIEP flap