title: "Mini-Flow-Through" Deep Inferior Epigastric Perforator Flap for Breast Reconstruction with Preservation of Both Internal Mammary and Deep Inferior Epigastric Vessels.
abstract: This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Satake
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Sugawara
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yasumura
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Mikami
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Maegawa
keywords: Granuloma; Mammaplasty; Microsurgery; Perforator flap; Subcutaneous mastectomy