"Mini-Flow-Through" Deep Inferior Epigastric Perforator Flap for Breast Reconstruction with Preservation of Both Internal Mammary and Deep Inferior Epigastric Vessels

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.

Keywords

Mammaplasty - Perforator flap - Microsurgery - Granuloma - Subcutaneous mastectomy

Publication History

Received: 15 June 2015

Accepted: 14 September 2015

Article published online:
05 May 2022

• References

• 1 Allen RJ. Perforator flaps in breast reconstruction. In: Spear SL. Surgery of the breast. Philadelphia: Lippincott-Raven; 1998: 605-625
• 2 Mennie JC, Mohanna PN, O'Donoghue JM. et al. Donor-site hernia repair in abdominal flap breast reconstruction: a population-based cohort study of 7929 patients. Plast Reconstr Surg 2015; 136: 1-9
• 3 Satake T, Torikai K, Takahashi T. et al. Experience using the deep inferior epigastric perforator (DIEP) flap for breast reconstruction. J Jpn Soc Plastic Reconstr Surg 2003; 23: 28-37
• 4 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645-648
• 5 Koshima I, Inagawa K, Yamamoto M. et al. New microsurgical breast reconstruction using free paraumbilical perforator adiposal flaps. Plast Reconstr Surg 2000; 106: 61-65
• 6 Schoeller T, Bauer T, Gurunluoglu R. et al. Modified free paraumbilical perforator flap: the next logical step in breast reconstruction. Plast Reconstr Surg 2003; 111: 1093-1098
• 7 Colohan S, Maia M, Langevin CJ. et al. The short- and ultrashort-pedicle deep inferior epigastric artery perforator flap in breast reconstruction. Plast Reconstr Surg 2012; 129: 331-340
• 8 Bauer TR, Schoeller T, Wechselberger G. et al. The radial artery perforator free flap. Plast Reconstr Surg 1999; 104: 885
• 9 Safak T, Akyurek M. Free transfer of the radial forearm flap with preservation of the radial artery. Ann Plast Surg 2000; 45: 97-99
• 10 Apostolides JG, Magarakis M, Rosson GD. Preserving the internal mammary artery: end-to-side microvascular arterial anastomosis for DIEP and SIEA flap breast reconstruction. Plast Reconstr Surg 2011; 128: 225e-232e
• 11 Follmar KE, Prucz RB, Manahan MA. et al. Internal mammary intercostal perforators instead of the true internal mammary vessels as the recipient vessels for breast reconstruction. Plast Reconstr Surg 2011; 127: 34-40
• 12 Moran SL, Nava G, Behnam AB. et al. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plast Reconstr Surg 2003; 111: 1876-1882
• 13 Mozaffarian D, Benjamin EJ, Go AS. et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2015; 131: e29-e322
• 14 Koshima I, Fujitsu M, Ushio S. et al. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg 2005; 115: 155-162
• 15 Rozen WM, Palmer KP, Suami H. et al. The DIEA branching pattern and its relationship to perforators: the importance of preoperative computed tomographic angiography for DIEA perforator flaps. Plast Reconstr Surg 2008; 121: 367-373