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The use of bi-pedicled DIEP flap for unilateral breast reconstruction: a 5-year retrospective study

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The deep inferior epigastric perforator (DIEP) flap is currently the flap of choice for autologous breast reconstruction. When the amount of tissue transferred needs to be maximised, a bi-pedicled DIEP flap allows harvesting the entire lower abdomen.


A retrospective analysis was conducted including patients who had unilateral breast reconstruction with bi-pedicled DIEP flaps between January 2013 and December 2017. Demographic information, operation notes and post-operative course were reviewed. Mann-Whitney-Wilcoxon and Fischer’s exact tests were used to look for a statistically significant association between complications and intra-operative modalities.


Forty-four cases were reviewed. Half of these patients underwent delayed breast reconstructions, 40.9% underwent immediate reconstructions and 10% were salvage cases. The majority of the cases (52.3%) had an initial anastomosis of the secondary pedicle to either a side branch (38.6%) or the superior continuity (13.6%) of the primary pedicle (intra-flap anastomosis). Twenty-seven percent of the intra-flap arterial anastomoses were performed using vessel couplers. The remaining 47.7% of the cohort had anastomoses of both pedicles to the internal mammary (IM) vessels anterogradely and retrogradely. There were no flap failures. The cases in which both pedicles were anastomosed with IM vessels had an overall higher complications rate, but were not related to flap failures or anastomotic issues. Intra-flap anastomosis on the other hand is a reliable alternative including the possibility of vessel coupler application to smaller arteries of this approach.


In our experience, bi-pedicled DIEP flaps are a safe alternative for unilateral breast reconstruction when the amount of harvested tissue needs to be maximised.

Level of evidence: Level III, therapeutic study.

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Georgios Christopoulos, Juan Enrique Berner, Theodoros N. Sergentanis, Adam Blackburn, and Simon P. Mackey declare that they have no conflict of interest.

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This is a retrospective study with a project protocol approved by institutional research and audit department of Queen Victoria Hospital NHS Trust. No further ethical approval was required.

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Christopoulos, G., Berner, J.E., Sergentanis, T.N. et al. The use of bi-pedicled DIEP flap for unilateral breast reconstruction: a 5-year retrospective study. Eur J Plast Surg 44, 325–332 (2021).

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