title: The Reconstruction Choice for Giant Phyllodes Tumor of Breast: Bi-pedicled Deep Inferior Epigastric Perforator Flap.
abstract: BACKGROUND
  Phyllodes tumors of the breast are the rarest of all breast neoplasms. Giant phyllodes tumors (>10 cm) of the breast have been less discussed in the literature. Reconstruction of the large defect created after wide excision (safety margin >1 cm) is a challenge in these patients. We present one technique using a bi-pedicled deep inferior epigastric perforator flap for post-mastectomy breast reconstruction for giant phyllodes tumors.
  
  
  RESULTS
  We treated three patients with giant phyllodes tumors between 2013 and 2016. The histological characteristics were benign and borderline; tumor sizes were 18 × 13 × 12, 20 × 16 × 9.5, and 18 × 15 × 9 cm. Immediate post-mastectomy reconstruction was performed using bi-pedicled deep inferior epigastric perforator flaps. Flap sizes measured 30 × 11, 28 × 12, and 28 × 13 cm. Total operative time, including that for mastectomy, was 285, 425, and 410 min. The duration of hospital stay was 12, 13, and 9 days. No local recurrence or distant metastasis occurred in the first two patients over a follow-up period of 3 years and in the third patient over a follow-up period of 6 months.
  
  
  CONCLUSIONS
  A higher local recurrence rate was associated with positive margins, histological grade, tumor size, and necrosis. Immediate post-mastectomy breast reconstruction may become the preferred option for treatment of giant phyllodes tumors. A bi-pedicled deep inferior epigastric perforator flap conferred adequate leverage for wide excision and resolved scar contracture of the axilla. Good functional and cosmetic results were achieved.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, #539, Jhongsiao Rd., Chia-Yi City, 60002, Taiwan. fangcl68@hotmail.com.
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Fang
authors.affiliation: Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, #539, Jhongsiao Rd., Chia-Yi City, 60002, Taiwan.
authors.forename: Chin-Hao
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Division of General Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, #539, Jhongsiao Rd., Chia-Yi City, 60002, Taiwan.
authors.forename: Chin-Wen
authors.initials: CW
authors.lastname: Tu
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D019074:Epigastric Arteries / Q000637:transplantation; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061525:Perforator Flap; D003557:Phyllodes Tumor / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D018570:Risk Assessment; D012494:Sampling Studies; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Bi-pedicled; DIEP; Giant; Phyllodes