title: Double transverse myocutaneous gracilis free flaps for unilateral breast reconstruction.
abstract: BACKGROUND
  In cases were the deep inferior epigastric perforator flap (DIEP flap) is not available and unilateral transverse myocutaneous gracilis flap (TMG flap) is not sufficient for breast reconstruction, we perform double TMG flaps as a reconstructive method. In this report, we present our results of the use of double TMG free-flap-transfer for unilateral breast reconstruction.
  
  
  METHODS
  Between August 2004 and June 2012 we performed 58 TMG flaps in 29 patients for unilateral breast reconstruction. Patient data were analyzed and operative outcome (operation time, complication rate and aesthetic results) were investigated. Aesthetic outcome was evaluated retrospectively via photo documentation by an independent plastic surgeon. The results were classified in;unsatisfactory, satisfactory, good and very good.
  
  
  RESULTS
  The average operating time was 6 hours 55 minutes (295 - 650 minutes). Of 58 TMG flaps, 57 (98.3%) were successful. Thrombosis occurred in seven (12%) cases (1 arterial, 6 venous). Flap salvage was successful in six cases and flap failure occurred in one (1.7%) case. The results of 25 patients were graded as good and very good. Three patients showed satisfying and one patient unsatisfying results.
  
  
  CONCLUSIONS
  Double TMG flaps in unilateral breast reconstruction could lead to good operative results. This method further expands the range of options with autologous tissue in reconstructive breast surgery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:539-545, 2016.
authors.affiliation: Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany. fwerdin@gmx.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Werdin
authors.affiliation: Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Haug
authors.affiliation: Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany.
authors.forename: Amro
authors.initials: A
authors.lastname: Amr
authors.affiliation: Department of Plastic Surgery, Microsurgery and Reconstructive Breastsurgery, Marienhospital Stuttgart, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schoeller
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D004954:Esthetics; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000637:transplantation*; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies