Seth Akhil K, Koolen Pieter G L, Sultan Steven M, Lee Bernard T, Erhard Heather A, Greenspun David T
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
J Reconstr Microsurg. 2019 Feb;35(2):145-155. doi: 10.1055/s-0038-1668161. Epub 2018 Aug 15.
The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint." This study summarizes our experience with using bipedicled DIEP flaps to improve the aesthetic results of unilateral breast reconstruction in such patients.
Consecutive patients undergoing unilateral breast reconstruction with bi-pedicled, conjoined DIEP flaps over a 4-year period were retrospectively reviewed. Primary and secondary flap microvascular anastomoses were performed to the antegrade internal mammary (IM) vessels and to either the retrograde IM vessels or a primary DIEP pedicle side branch, respectively. Clinical characteristics and outcomes were recorded.
Sixty-three patients underwent immediate ( = 29) or delayed ( = 34) reconstruction, with age and body mass index of 54.1 ± 8.4 years and 26.6 ± 4.7, respectively. Mean follow-up was 14.1 months. Twenty-eight (44.4%) patients received prereconstruction radiation therapy. All patients had preoperative abdominal imaging, including 57 (90.5%) using magnetic resonance angiography. There were no flap losses with three operative interventions for flap salvage.
Unilateral breast reconstruction with bipedicled, conjoined DIEP flaps is safe and reliable. These procedures can be performed with a complication profile similar to single-pedicle DIEP flaps. The additional skin and soft tissue available with bi-pedicled flaps allows for greater flexibility in matching the shape and projection of a woman's contralateral breast, and in some cases is necessary to achieve an aesthetically acceptable reconstruction. With growing expectations among breast reconstruction patients, conjoined bi-pedicled flaps represent a tool for meeting their reconstructive needs and exceeding the status quo for aesthetic outcomes.
腹部仍然是自体乳房重建最常用且可靠的供区。然而，一些患者缺乏足够的组织来使用单蒂的腹壁下深动脉穿支（DIEP）皮瓣再造一个美观的乳房隆起，尤其是在匹配对侧天然乳房时。由一个血管蒂可靠供应的腹部皮肤和/或软组织量常常不足以充分恢复乳房皮肤包膜和“足迹”。本研究总结了我们使用双蒂DIEP皮瓣改善此类患者单侧乳房重建美学效果的经验。
回顾性分析连续4年接受双蒂连体DIEP皮瓣进行单侧乳房重建的患者。分别将皮瓣的一级和二级微血管吻合至顺行的胸廓内血管以及逆行的胸廓内血管或DIEP皮瓣的一级蒂侧支。记录临床特征和结果。
63例患者接受了即刻（n = 29）或延迟（n = 34）重建，年龄和体重指数分别为54.1±8.4岁和26.6±4.7。平均随访14.1个月。28例（44.4%）患者在重建前接受了放疗。所有患者术前行腹部影像学检查，其中57例（90.5%）使用了磁共振血管造影。3次皮瓣挽救手术干预均未出现皮瓣丢失。
使用双蒂连体DIEP皮瓣进行单侧乳房重建是安全可靠的。这些手术的并发症情况与单蒂DIEP皮瓣相似。双蒂皮瓣提供的额外皮肤和软组织使得在匹配女性对侧乳房的形状和突出度方面具有更大的灵活性，并且在某些情况下对于实现美学上可接受的重建是必要的。随着乳房重建患者期望的不断提高，连体双蒂皮瓣是满足其重建需求并超越美学效果现状的一种手段。
