title: Use of both antegrade and retrograde internal mammary vessels in the bipedicled deep inferior epigastric perforator flap for unilateral breast reconstruction.
abstract: BACKGROUND
  Autologous abdominal tissue transfer is a well-established method of breast reconstruction. The deep inferior epigastric perforator (DIEP) flap has the additional benefit of minimal donor site morbidity as it spares the muscle and fascia. Conventional DIEP flaps may not provide adequate volume in cases where the patient is thin, has midline abdominal scars, and/or has a large volume of tissue to replace. One solution is to use a bipedicled DIEP flap, incorporating all the available abdominal tissue. Bipedicled DIEP flaps have been described in a number of different configurations. The literature appears to favor intra-flap anastomosis, with a minimal exposition of two recipient vessels. It has been demonstrated that both the antegrade internal mammary artery (aIMA) and retrograde internal mammary artery (rIMA) are adequate recipient vessels. Here, the authors present a single-center experience with bipedicled DIEP flaps to both the aIMA and rIMA, showing their feasibility and safety.
  
  
  METHODS
  A retrospective review of patients who underwent unilateral breast reconstruction using bipedicled DIEP flaps was performed to assess outcomes.
  
  
  RESULTS
  A total of 20 patients who underwent unilateral breast reconstruction using a bipedicled DIEP flap were selected for this study. All of them were previously diagnosed with cancer. There were zero flap failure and zero instance of abdominal hernia or issue with abdominal wall functionality following the surgeries.
  
  
  CONCLUSIONS
  The series of surgeries described in this study resulted in successful breast reconstruction in 20 women using a bipedicled DIEP flap. The results show that this approach allows for reconstruction in places where a conventional DIEP does not provide adequate volume, achieved safely, and does not increase morbidity. The bipedicled DIEP flap is a viable option for large-volume autologous breast reconstruction, providing ample tissue for successful reconstruction while also allowing for shorter recovery and limited donor site morbidity.
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA.
authors.forename: Jonatan
authors.initials: J
authors.lastname: Hernandez Rosa
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA. Electronic address: rami.sherif@icahn.mssm.edu.
authors.forename: Rami D
authors.initials: RD
authors.lastname: Sherif
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Torina
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Harmaty
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D019074:Epigastric Arteries / Q000637:transplantation*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000637:transplantation*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D061214:Patient Safety; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D012189:Retrospective Studies; D018570:Risk Assessment; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Bi-pedicle; Breast reconstruction; DIEP; Flap reconstruction; Microsurgery