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European Journal of Plastic Surgery

, Volume 36, Issue 11, pp 685–688 | Cite as

DIEAP flap selection for unilateral breast reconstruction: a comparison of flap side harvest

  • Hannah Eliza JohnEmail author
  • Colin Morrison
  • Michael Irwin
Original Paper
  • 124 Downloads

Abstract

Background

For breast reconstruction, the deep inferior epigastric artery perforator (DIEAP) flap can be harvested at the same side as that in mastectomy (ipsilateral) or from the contralateral hemi-abdomen. This paper seeks to establish the benefits of either side of DIEAP flap harvest, on the basis of our experience and a literature review.

Methods

We analysed our experience with the DIEAP flap and compared the two different technical approaches to flap harvesting. Using the internal mammary vessels as the standard recipient, with comparable vessels on either side, we compared the differences between harvesting on the contralateral and ipsilateral hemi-abdomen and analysed any references to it in the literature.

Results

Seventy-three DIEAP flaps were harvested for breast reconstruction, over a 2-year period, by the two senior authors. Of the 44 cases where the ipsilateral hemi-abdomen was used, this was the routine primary choice of the operating surgeon in 42 cases. The contralateral hemi-abdomen was the preferred choice in 29 cases. We accessed 302 papers related to the topic of breast reconstruction using a DIEAP flap, of which 63 papers were reviewed, based on the abstracts. Only six of these papers mentioned their routine or preferred choice of the hemi-abdomen.

Conclusions

There appears to be no consensus in the literature as to the preferred side of DIEAP flap harvest, if the perforators are of similar calibre and ease of dissection. Modern DIEAP flap harvest is based on the preoperative selection of the most reliable perforator. In relation to mastectomy defect, this may be on the ipsilateral or contralateral.

Level of Evidence: Level IV, prognostic/risk study

Keywords

DIEAP flap Breast reconstruction Ipsilateral hemi-abdomen Contralateral hemi-abdomen Deep inferior epigastric artery perforator flap 

Notes

Conflict of Interest

None

References

  1. 1.
    Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648PubMedCrossRefGoogle Scholar
  2. 2.
    Allen RJ, Treece P (1994) Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 32:32–38PubMedCrossRefGoogle Scholar
  3. 3.
    Weiler-Mithoff E, Hodgson ELB, Malata CM (2002) Perforator flap breast reconstruction. Breast Dis 16:93–106PubMedGoogle Scholar
  4. 4.
    Rozen WM, Garcia-Tutor E, Alonso-Burgos A, Acosta R, Stillaert F, Zubieta JL et al (2010) Planning and optimising DIEP flaps with virtual surgery: the Navarra experience. J Plast Reconstr Aesthet Surg 63:289–297Google Scholar
  5. 5.
    Taylor GI, Doyle M, McCarten G (1990) The Doppler probe for planning flap: anatomical study and clinical applications. Br J Plast Surg 43:1–16PubMedCrossRefGoogle Scholar
  6. 6.
    Rozen WM, Philips TJ, Ashton MW et al (2008) Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 121:9–16PubMedCrossRefGoogle Scholar
  7. 7.
    Blondeel P, Morrison C (2012) The deep inferior epigastric artery perforator flap. In: Neligan P, Gurtner G, Warren R, Rodriguez E, Song D, Grotting J, Chang J, Losee J, Van Beek A (eds) Plastic surgery, 3rd edn, Breast volume. New York, ElsevierGoogle Scholar
  8. 8.
    Hamdi M, Weiler-Mithoff E, Webster MHC (1999) Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps. Plast Reconstr Surg 103(1):86–95PubMedCrossRefGoogle Scholar
  9. 9.
    Hamdi M, Khuthaila DK, Landuyt KV, Roche N, Monstrey S (2007) Double-pedicle abdominal perforator free flaps for unilateral breast reconstruction: new horizons in microsurgical tissue transfer to the breast. J Plast Reconstr Aesthet Surg 60:904–912PubMedCrossRefGoogle Scholar
  10. 10.
    Blondeel PN, Hijjawi J, Depypere H, Roche N, Landuyt KV (2009) Shaping the breast in aesthetic and reconstructive breast surgery: an easy three step principle. Part II—Breast reconstruction after total mastectomy. Plast Reconstr Surg 123(3):794–805PubMedCrossRefGoogle Scholar
  11. 11.
    Dupin CL, Allen RJ, Glass CA, Bunch R (1996) The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 cases. Plast Reconstr Surg 98:685–691PubMedCrossRefGoogle Scholar
  12. 12.
    Granzow JW, Levine JL, Chiu ES, Allen RJ (2006) Breast reconstruction using perforator flaps. J Surg Oncol 94(6):441–454PubMedCrossRefGoogle Scholar
  13. 13.
    Granzow JW, Levine JL, Chiu ES, Allen RJ (2006) Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 59(6):571–579PubMedCrossRefGoogle Scholar
  14. 14.
    Jeevan R, Cromwell D, Browne J, Meulen J, Pereira J, Caddy C et al (2011) National mastectomy and breast reconstruction audit 2011. The NHS Information Centre; Document reference: IC20010111. www.rcseng.ac.uk/surgeons/research/surgical-research/docs/nationalmastectomy-and-breast-reconstruction-audit-fourth-report-2011. Accessed 14 May 2013

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hannah Eliza John
    • 1
    Email author
  • Colin Morrison
    • 1
  • Michael Irwin
    • 1
  1. 1.Department of Plastic and Reconstructive Surgery, Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK

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