Original articleDIEAP flap for safe definitive autologous breast reconstruction
Section snippets
Background
“An estimated 226,870 new cases of invasive breast cancer are expected to occur amongst women in the US during 2012. In addition, 63,300 new cases of in situ breast cancer are expected (www.cancer.org/statistics)”. Breast cancer is the commonest form of cancer in women resulting in ablation of the breast in about 30% of these patients. Also, more women are being diagnosed with BRCA (Breast Cancer) 1–3 genetic mutation associated with increased risk breast cancer. Many of these patients opt to
Patients and methods
The DIEAP flap procedure involves harvest of excess skin and subcutaneous fat from the lower abdomen that is discarded in a conventional abdominoplasty or “tummy tuck” procedure. This flap is perfused by perforator vessels that arise from the deep inferior epigastric vessels. While harvesting the flap, the blood vessels are carefully dissected along their course through the muscle, preserving the muscle and its nerves (Fig. 1). There is no need to harvest the muscle as is done with the
Results
Patients' age ranged from 22 to 77 years (Mean: 50 years). Adjuvant therapy was administered in the form of radiotherapy in 486 patients and chemotherapy in 440 patients (Table 1). Adjuvant radiotherapy was administered following the mastectomy in 468 patients. The breast reconstruction in these patients was carried out at least 6 month after the end of the radiotherapy. Adjuvant radiotherapy was administered after the microsurgical breast reconstruction with the DIEAP flap in 18 patients from
Discussion
Being affected by cancer has significant psychological impact on the well being of women [13], [14]. Fortunately, we can at least help address the physical impact of this major life-changing event and help restore the feminine form by reconstructing the breast. Breast reconstruction is achieved in various ways, either with a breast implant, with a latissimus dorsi muscle flap with or without an underlying implant or with autologous tissue from the abdomen, gluteal area or inner thigh. We would
Conclusions
In conclusion, the DIEAP flap is an excellent option for breast reconstruction resulting in an aesthetically pleasing restoration of the feminine form but with a low level of donor site morbidity and complications. This is the ideal form of breast reconstruction and surgeons in specialist breast reconstruction centres should promote experience in this technique.
Funding source
None.
Ethical approval
Not required as not an experimental study and privacy rights of human subjects has been observed.
Conflict of interest statement
None.
References (58)
- et al.
Estimates of cancer incidence and mortality in Europe in 2008
Eur J Cancer
(2010) One hundred free DIEP flap breast reconstructions: a personal experience
Br J Plast Surg
(1999)- et al.
Inferior epigastric artery skin flaps without rectus abdominis muscle
Br J Plast Surg
(1989) - et al.
Do pre-operative abdominal exercises prevent post-operative donor site complications for women undergoing DIEP flap breast reconstruction? A two-centre, prospective randomised controlled trial
Br J Plast Surg
(2003 Oct) - et al.
Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation
J Plast Reconstr Aesthet Surg
(2009 Nov) The use of tissue expanders in immediate breast reconstruction following mastectomy for cancer
Br J Plast Surg
(1990)- et al.
Is immediate autologous breast reconstruction with postoperative radiotherapy good practice?: a systematic review of the literature
J Plast Reconstr Aesthet Surg
(2013) - et al.
The latissimus dorsi musculocutaneous flap: a one-stage breast reconstruction
Clin Plast Surg
(1980) - et al.
A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap
Br J Plast Surg
(2000) - et al.
The DIEP flap breast reconstruction: starting from scratch in a university hospital
Ann Chir Plast Esthet
(2015)
Cancer facts and figures 2008
Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions
Plast Reconstr Surg
Deep inferior epigastric perforator flap for breast reconstruction
Ann Plast Surg
Preoperative imaging for perforator flaps in reconstructive surgery: a systematic review of the evidence for current techniques
Ann Plast Surg
The “Gent” consensus on perforator flap terminology: preliminary definitions
Plast Reconstr Surg
Comprehensive breast reconstruction in an academic surgical practice: an evaluation of the financial impact
Plast Reconst Surg
The impact of the medicare sustainable growth rate formula on reconstructive plastic surgery
Plast Reconstr Surg
Psychological effects of mastectomy on a woman's feminine self-concept
J Nerv Ment Dis
Psychological implications of mastectomy
Br J Soc Clin Psychol
A systemic review of complications and implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy
Ann Surg Oncol
Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast Cancer patients: a systematic review and meta-analysis
Plast Reconstr Surg
Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study
Plast Reconstr Surg
Immediate breast reconstruction in two stages using anatomical tissue expansion
Scand J Plast Reconstr Surg Hand Surg
Results of immediate breast reconstruction after skin-sparing mastectomy
Ann Plast Surg
Outcomes of delayed abdominal-based autologous reconstruction versus latissimus dorsi flap plus implant reconstruction in previously irradiated patients
Ann Plast Surg
Breast reconstruction after surgery for breast cancer
N. Engl J Med
A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications
Plast Reconstr Surg
Comparison of resource costs between implant-based and TRAM flap breast reconstruction
Plast Reconstr Surg
Cited by (21)
Secondary solution for breast reconstruction following total DIEP flap loss: A single-center experience after 3270 DIEP flaps
2024, Journal of Plastic, Reconstructive and Aesthetic SurgerySkin deformation analysis for pre-operative planning of DIEAP flap reconstruction surgery
2023, Medical Engineering and PhysicsThe perpetual changing paradigm in reconstructive surgery: Developing a vision for the future
2023, Journal of Plastic, Reconstructive and Aesthetic SurgeryComparison of surgical outcomes of free flap reconstructions performed by expert microsurgeons and trainees who completed a structured microsurgical training program in a teaching hospital
2020, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Since the introduction of various free flaps in the 1970s,1 microvascular surgery has become a crucial tool for the reconstruction of various defects. Based on our increased understanding of flap physiology and refinements in microsurgical instruments and techniques, reconstructions using free flaps are being successfully performed at rates exceeding 95% in large clinical series.2-5 Improvements in surgical outcomes enabled surgeons to choose the free flap as a primary reconstructive option.6
Automatic detection of perforators for microsurgical reconstruction
2020, BreastCitation Excerpt :Indications for free flap reconstruction underwent a considerable evolution over the last twenty years, and actually DIEP flaps are frequently done in immediate reconstruction, uni- or bilaterally, together with classic mastectomy and skin sparing techniques, and different skin approaches (like reduction patterns), either for cancer or for prophylactic reasons. Patient selection criteria also became less strict (e.g. diabetic, smokers), and several technical improvements have been progressively introduced [2]. One of the most important technical achievements was the pre-operative identification of the infra-umbilical perforator vessels.
Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study
2018, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :To our knowledge this is the first study to comprehensively assess abdominal-based breast reconstructions in a long-term perspective of a decade post-surgery. Previous studies have evaluated short-term data21,27–30 or in a long-term perspective only patient reported data.41 However, no study report both patient satisfaction and quality of life as well as external observer (professional and layman) outcomes.