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Bilateral DIEP flap breast reconstruction to a single set of internal mammary vessels : technique, safety, and outcomes after 250 flaps

(2019) PLASTIC AND RECONSTRUCTIVE SURGERY. 144(4). p.554E-564E
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Organization
Abstract
Background: The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. In bilateral cases, both flaps are often anastomosed to the internal mammary vessels on either side of the sternum. The authors propose a method in which both flaps are anastomosed to only the right side internal mammary artery and vein. Methods: Between November of 2009 and March of 2018, 125 patients underwent bilateral DIEP flap breast reconstruction with this technique. One flap is perfused by the anterograde proximal internal mammary artery and the second one by the retrograde distal internal mammary artery after presternal tunneling. Patient demographics and operative details were reviewed retrospectively. Results: Two hundred fifty flaps were performed. One hundred fifty-two flaps were prophylactic or primary reconstructions (60.8 percent), 70 were secondary reconstructions (28 percent), and 28 were tertiary reconstructions (11.2 percent). Mean patient age was 46 years, and the mean body mass index was 25 kg/m(2). Sixty patients underwent radiation therapy or chemotherapy (48 percent). The authors encountered one significant partial failure (0.4 percent) and nine complete flap failures (3.6 percent). The authors did not see a statistically significant predisposition for failure comparing the retrograde with the anterograde flow flaps, nor when comparing the tunneled with the nontunneled flaps. Conclusions: The authors' results show that anastomosing both DIEP flaps to a single set of mammary vessels is safe and reliable. The authors conclude that the retrograde flow through the distal internal mammary artery is sufficient for free flap perfusion and that subcutaneous tunneling of a free flap pedicle does not predispose to flap failure.
Keywords
EPIGASTRIC PERFORATOR FLAP, UNILATERAL BREAST, RECIPIENT VESSELS, RETROGRADE LIMB, BLOOD-FLOW, ARTERY, SATISFACTION, PATIENT, CANCER, VEIN

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MLA
Opsomer, Dries, et al. “Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels : Technique, Safety, and Outcomes after 250 Flaps.” PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 144, no. 4, 2019, pp. 554E-564E, doi:10.1097/PRS.0000000000006066.
APA
Opsomer, D., D’Arpa, S., Benmeridja, L., Stillaert, F., Noel, W., & Van Landuyt, K. (2019). Bilateral DIEP flap breast reconstruction to a single set of internal mammary vessels : technique, safety, and outcomes after 250 flaps. PLASTIC AND RECONSTRUCTIVE SURGERY, 144(4), 554E-564E. https://doi.org/10.1097/PRS.0000000000006066
Chicago author-date
Opsomer, Dries, Salvatore D’Arpa, Lara Benmeridja, Filip Stillaert, Warren Noel, and Koenraad Van Landuyt. 2019. “Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels : Technique, Safety, and Outcomes after 250 Flaps.” PLASTIC AND RECONSTRUCTIVE SURGERY 144 (4): 554E-564E. https://doi.org/10.1097/PRS.0000000000006066.
Chicago author-date (all authors)
Opsomer, Dries, Salvatore D’Arpa, Lara Benmeridja, Filip Stillaert, Warren Noel, and Koenraad Van Landuyt. 2019. “Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels : Technique, Safety, and Outcomes after 250 Flaps.” PLASTIC AND RECONSTRUCTIVE SURGERY 144 (4): 554E-564E. doi:10.1097/PRS.0000000000006066.
Vancouver
1.
Opsomer D, D’Arpa S, Benmeridja L, Stillaert F, Noel W, Van Landuyt K. Bilateral DIEP flap breast reconstruction to a single set of internal mammary vessels : technique, safety, and outcomes after 250 flaps. PLASTIC AND RECONSTRUCTIVE SURGERY. 2019;144(4):554E-564E.
IEEE
[1]
D. Opsomer, S. D’Arpa, L. Benmeridja, F. Stillaert, W. Noel, and K. Van Landuyt, “Bilateral DIEP flap breast reconstruction to a single set of internal mammary vessels : technique, safety, and outcomes after 250 flaps,” PLASTIC AND RECONSTRUCTIVE SURGERY, vol. 144, no. 4, pp. 554E-564E, 2019.
@article{8698183,
  abstract     = {{Background: The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. In bilateral cases, both flaps are often anastomosed to the internal mammary vessels on either side of the sternum. The authors propose a method in which both flaps are anastomosed to only the right side internal mammary artery and vein. Methods: Between November of 2009 and March of 2018, 125 patients underwent bilateral DIEP flap breast reconstruction with this technique. One flap is perfused by the anterograde proximal internal mammary artery and the second one by the retrograde distal internal mammary artery after presternal tunneling. Patient demographics and operative details were reviewed retrospectively. Results: Two hundred fifty flaps were performed. One hundred fifty-two flaps were prophylactic or primary reconstructions (60.8 percent), 70 were secondary reconstructions (28 percent), and 28 were tertiary reconstructions (11.2 percent). Mean patient age was 46 years, and the mean body mass index was 25 kg/m(2). Sixty patients underwent radiation therapy or chemotherapy (48 percent). The authors encountered one significant partial failure (0.4 percent) and nine complete flap failures (3.6 percent). The authors did not see a statistically significant predisposition for failure comparing the retrograde with the anterograde flow flaps, nor when comparing the tunneled with the nontunneled flaps. Conclusions: The authors' results show that anastomosing both DIEP flaps to a single set of mammary vessels is safe and reliable. The authors conclude that the retrograde flow through the distal internal mammary artery is sufficient for free flap perfusion and that subcutaneous tunneling of a free flap pedicle does not predispose to flap failure.}},
  author       = {{Opsomer, Dries and D'Arpa, Salvatore and Benmeridja, Lara and Stillaert, Filip and Noel, Warren and Van Landuyt, Koenraad}},
  issn         = {{0032-1052}},
  journal      = {{PLASTIC AND RECONSTRUCTIVE SURGERY}},
  keywords     = {{EPIGASTRIC PERFORATOR FLAP,UNILATERAL BREAST,RECIPIENT VESSELS,RETROGRADE LIMB,BLOOD-FLOW,ARTERY,SATISFACTION,PATIENT,CANCER,VEIN}},
  language     = {{eng}},
  location     = {{Madrid, Spain}},
  number       = {{4}},
  pages        = {{554E--564E}},
  title        = {{Bilateral DIEP flap breast reconstruction to a single set of internal mammary vessels : technique, safety, and outcomes after 250 flaps}},
  url          = {{http://dx.doi.org/10.1097/PRS.0000000000006066}},
  volume       = {{144}},
  year         = {{2019}},
}

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