Banking a Hemi-Abdominal DIEP – Case Series and Economic Model

The authors presented the idea of “banking” the contralateral hemi-DIEP flap under the abdominal closure in patients undergoing unilateral autologous breast reconstruction when a hemi-abdominal flap suffices.

Three patients undergoing unilateral autologous breast reconstruction with a hemi-abdominal DIEP flap had their contralateral hemi-abdominal flap left in position or “banked” under their abdominal closure, to be used in case of failure. An economic analysis of this technique was performed.

The patients' index free hemi-DIEP flaps survived, and patients were taken back to the operating room on postoperative day 2, at which time their abdominal closures were re-opened and the remaining banked flap was excised. Economic analysis of banking a hemi-abdominal free flap based on historical and contemporary cost data suggests that it is a logical technique if the chance of index flap failure is greater than 10%. The variables, assumptions, and equations on which this result is based were presented.

The novel method of banking a hemi-abdominal DIEP flap may be of assistance when a free hemi-abdominal flap is thought to be threatened. It provides a lifeboat for the novice and experienced surgeon alike and, most important, for the breast cancer survivor. Economic analysis of the technique reveals that the contralateral hemi-abdominal flap should be banked more often than intuition alone would suggest.