Approach to DIEP Flap Pedicle Dissection via a Midline Fascial Incision.

In this article, our technique for deep inferior epigastric pedicle dissection utilizing a midline fascial incision is described. Approaching these vessels via a midline facial incision provides facile access to the retrorectus space bilaterally, utilizes a dissection plane that facilitates preservation of nerve and muscle fibers, and allows for both efficient and ergonomic pedicle dissection. This method is safe and easily reproducible and may reduce abdominal donor site morbidity in deep inferior epigastric perforator flap breast reconstruction.

Effect of Enhanced Recovery After Surgery in Morbidly Obese Patients Undergoing Free Flap Breast Reconstruction.

Background: Enhanced Recovery After Surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have yet to be defined.

Methods: A retrospective chart review of patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our institution from 2017 to 2022 was performed.

Breast sensibility after reconstruction: Comparison of different methods.

Background And Objectives: Sensibility of the breast area is a key factor in quality-of-life evaluation after breast reconstruction (BR). Breast sensation can be assessed using numerous tools that are already largely described in the literature, including the Semmes Weinstein filaments which remain the most frequently used. Although different reconstruction techniques are available, post-BR sensitivity is rarely described.

Combined chest wall perforator flap and synchronous fat grafting for partial breast reconstruction.

Chest wall perforator flaps (CWPFs) have been a well-recognised surgical option for volume replacement following breast conservation surgery (BCS). However, the flap volume can sometimes be limited, which may adversely affect the aesthetic outcome or even disqualify the patient from having BCS. We report the first case of hybrid partial breast reconstruction using immediate autologous fat injection into CWPF.

Breast-Conserving Surgery with Immediate Partial Breast Reconstruction by Using Pedicled Thoracodorsal Artery Perforator Flap: A 7-Year Follow-Up of 50 Women.

Introduction: Thoracodorsal artery perforator (TDAP) flap has been used for more than 10 years in the immediate partial breast reconstruction (IPBR) of breast cancer, allowing many patients to maximize reserved autologous breast tissue who do not have indications for breast-conserving surgery (BCS). No large sample size survival data for this operation have been reported worldwide.

Methods: There are 212 primary breast cancer patients who were prepared to receive BCS with IPBR of pedicled TDAP flaps in our institution from June 2013 to December 2017.

Oncoplastic breast reconstruction with single-port laparoscopically harvested omental flap: insights from a ten-year tertiary center experience.

Purpose: To evaluate the 10-year functional and oncological outcomes of single-port laparoscopically harvested omental flap (SLOF) for immediate breast reconstruction after breast cancer surgery. The technical feasibility and oncologic safety of breast reconstruction using a laparoscopically harvested omental flap remain controversial.

Methods: We examined 236 patients with breast cancer (including 2 patients with malignant phyllodes tumors) who underwent nipple-sparing mastectomy or breast-conserving surgery followed by immediate SLOF reconstruction between February 2015 and March 2024 at our institution.

Unilateral Versus Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review and Meta-analysis.

Background: Previous studies have shown a higher complication rate in bilateral (BL) compared to unilateral (UL) deep inferior epigastric perforator (DIEP) flap breast reconstructions. This systematic review and meta-analysis aimed to offer an update by including recent studies to thoroughly assess the complication rates in UL versus BL DIEP flap reconstructions and provide clear guidance for clinicians and their patients.

Methods: A systematic review of the literature and comparative meta-analysis were performed to assess the differences in complication rates between UL and BL procedures.

Technical and Analytical Approach for Breast Reconstruction With IMAP Propeller Flap.

Background: The breast-sharing technique uses the lower quadrants discarded from a contralateral symmetrizing reduction mammoplasty to reconstruct the breast after mastectomy. The aim of our study was to revisit this old technique and to improve its vascular predictability by preoperative computed tomography angiography (angio-CT) and intraoperative indocyanine green (ICG) imaging.

Methods: Twenty-six patients were enrolled and assessed by a preoperative angio-CT to localize and evaluate the internal mammary artery perforator (IMAP).

Secondary Revision after Breast Reconstruction with Free Abdominal Perforator Flap: Flap Liposuction and Inframammary Fold Reconstruction.

Background: In breast reconstruction using the abdominal perforator flap, if the flap capacity is too large, secondary revision procedures can be performed to reduce flap volume and reconstruct the inframammary fold (IMF). We examined the various revision methods and cosmetic results.

Methods: This study included 28 patients who underwent secondary revision among 216 patients who had breast reconstruction using the abdominal perforator flap between April 2012 and March 2019.

Maximizing Aesthetic Outcomes in Delayed Breast Reconstruction: the Be.A.U.T-I.F.U.L. DIEP Step-by-Step Inset Technique.

Introduction: In microvascular breast reconstruction, the focus has shifted to achieving aesthetically pleasing results. Delayed breast reconstruction poses challenges such as ensuring natural ptosis and avoiding a "patch" effect. The Be.

Semiautomatic Quantitative Assessment of DIEP Flap Volume and Thickness for Breast Reconstruction using CTA Data and Implications in Postoperative Complications.

Accurately assessing flap volume and thickness is a crucial aspect of breast reconstruction using the deep inferior epigastric perforator (DIEP) flap, especially in challenging cases such as thin or large-breasted women or bilateral reconstruction. To address this, we present an innovative image processing tool utilizing computed tomography angiography (CTA) to measure DIEP flap volume and thickness. Our approach incorporates an elliptical equation validated on DIEP reconstruction patients.

Local recurrences after DIEP reconstruction of the breast - Epidemiology and strategies for treatment.

Breast cancer is the most common cancer diagnosed in women. Breast reconstruction can be performed with autologous fat tissue, implants, or a combination of both. Overall, there is no increased risk of breast cancer recurrence after autologous breast reconstruction compared to mastectomy alone.

Color differences of skin paddles using the free flap for autologous breast reconstruction in Asian patients.

Background: In this study, we aimed to evaluate color differences of the skin paddle in autologous breast reconstruction performed using the deep inferior epigastric artery perforator (DIEP) flap and the profunda artery perforator (PAP) flap. The primary focus was to compare the color match between the reconstructed breast skin and the donor-site skin, to achieve optimal esthetic results.

Methods: A retrospective analysis was performed on patients who had undergone unilateral breast reconstruction with a DIEP flap or a PAP flap between January 2020 and December 2022.

Donor Site Outcomes Following Autologous Breast Reconstruction with DIEP Flap: A Retrospective and Prospective Study in a Single Institution.

The deep inferior epigastric perforator artery (DIEP) free flap is the most commonly performed autologous breast reconstruction. Despite the relative reduction in donor site complications compared to nonmuscle-sparing options, there is still high morbidity associated with this surgery. The purpose of this study is to compare outcomes and complications at our institution and to discuss potential quality improvement initiatives.

Evolving Methods and Application of a 3D Printed Model in the Current Deep Inferior Epigastric Perforator Flap Elevation.

Background: The choice of the deep inferior epigastric perforator (DIEP) flap for breast reconstruction has increased. Three-dimensional (3D) models of DIEP flaps have been introduced with advances in 3D technology to assist the tedious intramuscular dissection of the pedicle. This study presents the process of creating an ideal 3D model for a DIEP flap.

Internal mammary artery perforator-based plug flap.

Introduction: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fascio-cutaneous pedicled chest wall perforator flaps or local perforator flaps (CWPF).

Case Presentation: We present a case of reconstruction with internal mammary artery perforator (IMAP)-based plug flap to fill the infero-medial defect caused by a tumor close to skin, with visible retraction.

Bilobed lateral artery perforator-based flap for partial breast reconstruction - Technique description and results from a ten-year cohort.

Introduction: We present a new technique, the bilobed lateral artery perforator-based flap, for breast-conserving surgery of large central tumors or nearby, combining Zymany's bilobed flap and a Lateral Intercostal Perforator (LICAP) flap, and its 10-year outcomes.

Materials And Methods: We studied 37 patients with malignant breast tumors near or involving the central skin, without ptosis or desire to correct it, who avoided mastectomy with this modified bilobed flap from 2013 to 2022. The same surgeon operated on them in different institutions.

The Impact of Depression and Anxiety Comorbidities on Acute Postoperative Pain After DIEP Flap Breast Reconstruction.

Background: Depression and anxiety have a complex association with opioid dependence, though their impact on acute postoperative pain is unclear. The present study investigated the impact of depression and anxiety on acute postoperative pain and opioid requirements following deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods: Patients receiving DIEP flap breast reconstruction were retrospectively identified from 2019 to 2023.

The enhanced-view totally extraperitoneal repair of abdominal bulge after DIEP flap breast reconstruction for breast cancer: a case report.

Background: The deep inferior epigastric perforator (DIEP) flap for autologous breast reconstruction is associated with higher patient satisfaction and fewer abdominal morbidities at the donor site than the transverse rectus abdominis myocutaneous flap. However, abdominal bulging occurs at a certain frequency, and there is no established treatment. Here, we present a case of laparoscopic hernia repair using the enhanced-view totally extraperitoneal (eTEP) method in a patient with a lower abdominal bulge after DIEP flap reconstruction.

Management of Delayed Vascular Occlusion in Free Flap Breast Reconstruction: A Systematic Review of Literature and Case Report.

Introduction: Free flap surgery is a reliable and safe procedure for breast reconstruction. The survival of free flaps depends on their vascular pedicle initially, but neovascularization can sustain their blood supply after a while. Management of late pedicle occlusion in free flap breast reconstruction and potential implications of late pedicle occlusion on the transferred tissue are controversial.

Double Medial Circumflex Femoral Artery Perforator Flaps for Unilateral Breast Reconstruction-A Case Report.

Thigh-based free flaps are a common second-line options in autologous breast reconstruction when the abdominal donor site is unavailable. While the profunda artery perforator (PAP) flap and gracilis-based flaps are most commonly utilized in this scenario, certain anatomic variations may favor alternative flap selection. One such option is the medial circumflex femoral artery perforator flap (MCFLAP).