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Breast Reconstruction with Perforator Flap Transplants from Identical Twins

  • Thais O. Polanco
  • Robert J. AllenJr.Email author
  • Robert J. AllenSr.
Chapter
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Abstract

Many technical advances in the field of microvascular surgery have surfaced since the advent of the first successful kidney transplantation. Identical twin transplantation has the advantage of transferring tissue without immunologic barriers, thus not subjecting patients to the adverse events secondary to immunosuppressive drugs and of rejection. Perforator free flaps, specifically the DIEP flap, have become the gold standard for autologous breast reconstruction (ABR) – resulting in less donor-site morbidity and excellent aesthetic results. Challenges in some patients electing ABR include history of failed breast reconstruction, previous abdominal surgeries, and thin body habitus. When situations such as these arise, it is feasible to perform a perforator free flap transplantation in monozygotic twins. In this chapter, the authors review their unique clinical experience in breast reconstruction with transplantation of perforator free flaps from one identical twin to another.

Keywords

Breast reconstruction Microsurgery Identical twins Syngeneic isotransplantation 

References

  1. 1.
    Merrill JP, Murray JE, Harrison JH, Guild WR. Successful homotransplantation of the human kidney between identical twins. JAMA. 1956;160:277.CrossRefGoogle Scholar
  2. 2.
    Morris PJ. Transplantation: a medical miracle of the 20th century. N Engl J Med. 2004;351:2678–80.CrossRefGoogle Scholar
  3. 3.
    Schena S, Testa G, Setty S, Abcarian H, Benedetti E. Successful identical-twin living donor small bowel transplant for necrotizing enterovasculitis secondary to Churg-Strauss syndrome. Transpl Int. 2006;19:594.CrossRefGoogle Scholar
  4. 4.
    Cohen JM, Rogers V, Gaspar HB, et al. Serial transplantation of mismatched donor hematopoietic cells between HLA identical sibling pairs with congenital immunodeficiency: in vivo tolerance permits rapid immune reconstitution following T-replete transplantation without GVHD in the secondary recipient. Blood. 2006;108:2124.CrossRefGoogle Scholar
  5. 5.
    Silber SJ, Lenahan KM, Levine DJ, et al. Ovarian transplantation between monozygotic twins discordant for premature ovarian failure. N Engl J Med. 2005;353:58.CrossRefGoogle Scholar
  6. 6.
    Liu LU, Schiano TD, Min AD, et al. Syngeneic living donor liver transplantation without the use of immunosuppression. Gastroenterology. 2002;123:1341.CrossRefGoogle Scholar
  7. 7.
    Benedetti E, Dunn T, Massad MG, et al. Successful living related simultaneous pancreas-kidney transplant between identical twins. Transplantation. 1999;67:915.CrossRefGoogle Scholar
  8. 8.
    Kortholm B. Transplantation between monozygotic twins. Scand J Plast Reconstr Surg. 1968;2:64.CrossRefGoogle Scholar
  9. 9.
    Allen RJ Jr, et al. Transplantation in identical twins: another option for breast reconstruction. Plast Reconstr Surg. 2008;122(4):1019–23.CrossRefGoogle Scholar
  10. 10.
    Koshima I, Soeda S. Inferior epigastric artery skin flap without rectus abdominis muscle. Br J Plast Surg. 1989;42:645.CrossRefGoogle Scholar
  11. 11.
    Allen RJ, Heitland AS. Superficial inferior epigastric artery flap for breast reconstruction. Semin Plast Surg. 2002;16:35.CrossRefGoogle Scholar
  12. 12.
    Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32:32.CrossRefGoogle Scholar
  13. 13.
    Guerra AB, Metzinger SE, Bidros RS, et al. Bilateral breast reconstruction with the Deep Inferior Epigastric Perforator (DIEP) flap: an experience with 280 flaps. Ann Plast Surg. 2004;52:246–52.CrossRefGoogle Scholar
  14. 14.
    Keller A. The deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 2001;46:474–80.CrossRefGoogle Scholar
  15. 15.
    Hamdi M, Weiler-Mithoff EM, Webster MH. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps. Plast Reconstr Surg. 1999;103:86–95.CrossRefGoogle Scholar
  16. 16.
    Blondeel N, Vanderstraeten GG, Monstrey SJ, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg. 1997;50:322.CrossRefGoogle Scholar
  17. 17.
    Garvey PB, Buchel EW, Pockaj BA, et al. DIEP and pedicled TRAM flaps: a comparison of outcomes. Plast Reconstr Surg. 2006;117:1711.CrossRefGoogle Scholar
  18. 18.
    Kaplan JL, Allen RJ. A cost-based analysis of perforator flaps vs. TRAM flaps in breast reconstruction. Plast Reconstr Surg. 2000;105:943.CrossRefGoogle Scholar
  19. 19.
    Hazani R, et al. Bilateral breast reconstruction: the simultaneous use of autogenous tissue and identical twin isograft. Ann Plast Surg. 2009;63(5):496–8.CrossRefGoogle Scholar
  20. 20.
    Martin J, Hamilton B, Osterman M. Three decades of twin births in the United States. NCHS Data Brief. 1980–2009;2012:1–8.Google Scholar
  21. 21.
    Kulkarni AD, Jamieson DJ, Jones HW Jr, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369:2218–25.CrossRefGoogle Scholar
  22. 22.
    Toledo MG. Is there increased monozygotic twinning after assisted reproductive technology? Aust N Z J Obstet Gynaecol. 2005;45:360–4.CrossRefGoogle Scholar
  23. 23.
    Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol. 2004;18:557–76.CrossRefGoogle Scholar
  24. 24.
    Aston KI, Peterson CM, Carrell DT. Monozygotic twinning associated with assisted reproductive technologies: a review. Reproduction. 2008;136:377–86.CrossRefGoogle Scholar
  25. 25.
    Vitthala S, Gelbaya TA, Brison DR, Fitzgerald CT, Nardo LG. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod Update. 2009;15:45–55.CrossRefGoogle Scholar
  26. 26.
    Mack TM, Peto J. High constant incidence in twins and other relatives of women with breast cancer. Nat Genet. 2000;26:411.CrossRefGoogle Scholar
  27. 27.
    Möller S, et al. The heritability of breast cancer among women in the Nordic Twin Study of Cancer. Cancer Epidemiol Prev Biomark. 2016;25(1):145–50.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Thais O. Polanco
    • 1
  • Robert J. AllenJr.
    • 1
    Email author
  • Robert J. AllenSr.
    • 2
  1. 1.Department of Plastic and Reconstructive SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of SurgeryOchsner Medical Center, LSU Health SciencesNew OrleansUSA

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