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The Extended Diep Flap

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Breast Reconstruction

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Abstract

The authors describe the history of breast reconstruction and the anatomy of the DIEP flap including the arterial system of the anterior abdominal wall, DIEA musculocutaneous perforators, DIEA perfusion zones and the venous system of the anterior abdominal wall. There is a discussion of the extended DIEP Flap, extended DIEP by vasculature (stacked flap) and extended DIEP by volume (shelving flap).

In recent decades, encouraged by improved imaging and microsurgical techniques, postmastectomy autologous breast reconstruction has become popular. The reconstructive options have evolved significantly over time and currently, the DIEP flap is considered the gold standard

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References

  1. DeSantis C, Ma J, Bryan L, Jemal A (2014) Breast cancer statistics, 2013. CA Cancer J Clin 64(1):52–62

    Article  PubMed  Google Scholar 

  2. Shons AR, Mosiello G (2001) Postmastectomy breast reconstruction: current techniques. Cancer Control 8(5):419–426

    PubMed  CAS  Google Scholar 

  3. Spear SL, Onyewu C (2000) Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg 105(3):930–942

    Article  PubMed  CAS  Google Scholar 

  4. Kroll SS (1998) Why autologous tissue? Clin Plast Surg 25(2):135–143

    PubMed  CAS  Google Scholar 

  5. Rozen WM, Rajkomar AK, Anavekar NS, Ashton MW (2009) Post-mastectomy breast reconstruction: a history in evolution. Clin Breast Cancer 9(3):145–154

    Article  PubMed  Google Scholar 

  6. Hamdi M, Khuthaila DK, Van Landuyt K, 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(8):904–912

    Article  PubMed  Google Scholar 

  7. Blondeel PN (1999) One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 52(2):104–111

    Article  PubMed  CAS  Google Scholar 

  8. Healy C, Allen RJ Sr (2014) The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 30(2):121–125

    PubMed  Google Scholar 

  9. Czerny V (1895) Plastischer ersatz der brustdrusse durch ein lipom. Drei Plastiche Operationen Verhand Deutsch Gesellsch Chir 24:216–217

    Google Scholar 

  10. Czerny V (1895) Plastischer ersatz der brustdrusse durch ein lipom. Zentralbl Chir 27:72

    Google Scholar 

  11. Kiricuta I (1963) The use of the great omentum in the surgery of breast cancer. Presse Med 71:15–17

    PubMed  CAS  Google Scholar 

  12. Schneider WJ, Hill HL Jr, Brown RG (1977) Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 30(4):277–281

    Article  PubMed  CAS  Google Scholar 

  13. Muhlbauer W, Olbrisch R (1977) The latissimus dorsi myocutaneous flap for breast reconstruction. Chir Plast 4:27 (Abstract)

    Article  Google Scholar 

  14. Olivari N (1976) The latissimus flap. Br J Plast Surg 29(2):126–128

    Article  PubMed  CAS  Google Scholar 

  15. Saijo M (1978) The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites. Br J Plast Surg 31(3):200–204

    Article  PubMed  CAS  Google Scholar 

  16. Hokin JA (1983) Mastectomy reconstruction without a prosthetic implant. Plast Reconstr Surg 72(6):810–818

    Article  PubMed  CAS  Google Scholar 

  17. Marshall DR, Anstee EJ, Stapleton MJ (1984) Soft tissue reconstruction of the breast using an extended composite latissimus dorsi myocutaneous flap. Br J Plast Surg 37(3):361–368

    Article  PubMed  CAS  Google Scholar 

  18. Germann G, Steinau HU (1996) Breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 97(3):519–526

    Article  PubMed  CAS  Google Scholar 

  19. McCraw JB, Papp CT (1991) Latissimus dorsi myocutaneous flap: “Fleur de lis” reconstruction. In: Hartrampf CR (ed) Breast reconstruction with living tissue. Hampton Press, Norfolk, p 211

    Google Scholar 

  20. Denewer A, Setit A, Hussein O, Farouk O (2008) Skin-sparing mastectomy with immediate breast reconstruction by a new modification of extended latissimus dorsi myocutaneous flap. World J Surg 32(12):2586–2592

    Article  PubMed  Google Scholar 

  21. Taylor GI, Daniel RK (1975) The anatomy of several free flap donor sites. Plast Reconstr Surg 56(3):243–253

    Article  PubMed  CAS  Google Scholar 

  22. Hartrampf CR Jr, Noel RT, Drazan L, Elliott FL, Bennett GK, Beegle PH (1994) Ruben’s fat pad for breast reconstruction: a peri-iliac soft-tissue free flap. Plast Reconstr Surg 93(2):402–407

    Article  PubMed  Google Scholar 

  23. Serafin D, Georgiade NG (1978) Transfer of free flaps to provide well-vascularized, thick cover for breast reconstructions after radical mastectomy. Plast Reconstr Surg 62(4):527–536

    Article  PubMed  CAS  Google Scholar 

  24. Elliott LF, Beegle PH, Hartrampf CR Jr (1990) The lateral transverse thigh free flap: an alternative for autogenous-tissue breast reconstruction. Plast Reconstr Surg 85(2):169–178

    Article  PubMed  CAS  Google Scholar 

  25. Fujino T, Harasina T, Aoyagi F (1975) Reconstruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock. Plast Reconstr Surg 56(2):178–181

    Article  PubMed  CAS  Google Scholar 

  26. Fujino T, Abe O, Enomoto K (1981) Primary reconstruction of the breast by free myocutaneous gluteal flap. Int Adv Surg Oncol 4:127–143

    PubMed  CAS  Google Scholar 

  27. Shaw WW (1983) Breast reconstruction by superior gluteal microvascular free flaps without silicone implants. Plast Reconstr Surg 72(4):490–501

    Article  PubMed  CAS  Google Scholar 

  28. Paletta CE, Bostwick J 3rd, Nahai F (1989) The inferior gluteal free flap in breast reconstruction. Plast Reconstr Surg 84(6):875–883

    Article  PubMed  CAS  Google Scholar 

  29. Peek A, Muller M, Exner K (2002) The free gracilis perforator flap for autologous breast reconstruction. Handchir Mikrochir Plast Chir 34(4):245–250

    Article  PubMed  CAS  Google Scholar 

  30. Hartrampf CR Jr, Elliott LF, Feldman S (1990) A triceps musculocutaneous flap for chest-wall defects. Plast Reconstr Surg 86(3):502–509

    Article  PubMed  Google Scholar 

  31. Robbins TH (1979) Rectus abdominis myocutaneous flap for breast reconstruction. Aust N Z J Surg 49(5):527–530

    Article  PubMed  CAS  Google Scholar 

  32. Holmstrom H (1979) The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg 13(3):423–427

    Article  PubMed  CAS  Google Scholar 

  33. Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225

    Article  PubMed  CAS  Google Scholar 

  34. Cohen BE, Cronin ED (1984) Breast reconstruction with the latissimus dorsi musculocutaneous flap. Clin Plast Surg 11(2):287–302

    PubMed  CAS  Google Scholar 

  35. Nahabedian MY, Momen B, Galdino G, Manson PN (2002) Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 110(2):466–475

    Article  PubMed  Google Scholar 

  36. Nahabedian MY, Tsangaris T, Momen B (2005) Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference? Plast Reconstr Surg 115(2):436–444

    Article  PubMed  Google Scholar 

  37. Taylor GI, Corlett RJ, Boyd JB (1984) The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg 37(3):330–350

    Article  PubMed  CAS  Google Scholar 

  38. Onishi K, Maruyama Y, Iwahira Y (1986) Cutaneous and fascial vasculature of the leg: anatomic study of fasciocutaneous vessels. J Reconstr Microsurg 2(3):181–189

    Article  PubMed  CAS  Google Scholar 

  39. Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N (1992) Free thin paraumbilical perforator-based flaps. Ann Plast Surg 29(1):12–17

    Article  PubMed  CAS  Google Scholar 

  40. Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42(6):645–648

    Article  PubMed  CAS  Google Scholar 

  41. Allen RJ, Treece P (1994) Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 32(1):32–38

    Article  PubMed  CAS  Google Scholar 

  42. Bottero L, Lefaucheur JP, Fadhul S, Raulo Y, Collins ED, Lantieri L (2004) Electromyographic assessment of rectus abdominis muscle function after deep inferior epigastric perforator flap surgery. Plast Reconstr Surg 113(1):156–161

    Article  PubMed  Google Scholar 

  43. Kroll SS, Sharma S, Koutz C, Langstein HN, Evans GRD, Robb GL, Chang DW, Reece GP (2001) Postoperative morphine requirements of free TRAM and DIEP flaps. Plast Reconstr Surg 107(2):338–341

    Article  PubMed  CAS  Google Scholar 

  44. Gill PS, Hunt JP, Guerra AB, Dellacroce FJ, Sullivan SK, Boraski J, Metzinger SE, Dupin CL, Allen RJ (2004) A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 113(4):1153–1160

    Article  PubMed  Google Scholar 

  45. Rozen WM, Chubb D, Grinsell D, Ashton MW (2011) Computed tomographic angiography: clinical applications. Clin Plast Surg 38(2):229–239

    Article  PubMed  Google Scholar 

  46. Rozen WM, Ribuffo D, Atzeni M, Stella DL, Saba L, Guerra M, Grinsell D, Ashton MW (2009) Current state of the art in perforator flap imaging with computed tomographic angiography. Surg Radiol Anat 31(8):631–639

    Article  PubMed  Google Scholar 

  47. Rozen WM, Anavekar NS, Ashton MW, Stella DL, Grinsell D, Bloom RJ, Taylor GI (2008) Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction? Microsurgery 28(7):516–523

    Article  PubMed  Google Scholar 

  48. Rozen WM, Ashton MW, Grinsell D, Stella DL, Phillips TJ, Taylor GI (2008) Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforators. Microsurgery 28(5):306–313

    Article  PubMed  CAS  Google Scholar 

  49. Taylor GI (2003) The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 30(3):331–342

    Article  PubMed  Google Scholar 

  50. Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40(2):113–141

    Article  PubMed  CAS  Google Scholar 

  51. Boyd JB, Taylor GI, Corlett R (1984) The vascular territories of the superior epigastric and the deep inferior epigastric systems. Plast Reconstr Surg 73(1):1–16

    Article  PubMed  CAS  Google Scholar 

  52. Salmon M, Taylor GI, Tempest MN (1987) Arteries of the skin. Churchill Livingstone, London

    Google Scholar 

  53. Manchot C (1889) Die Hautarterien des menschlichen Korpers. Vogel, Leipzig, pp 1–120

    Google Scholar 

  54. Manchot C (1983) The cutaneous arteries of the human body (Ristic J, Morain WD, transls.). Springer, New York

    Google Scholar 

  55. Moon HK, Taylor GI (1988) The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 82(5):815–832

    Article  PubMed  CAS  Google Scholar 

  56. Milloy FJ, Anson BJ, McAfee DK (1960) The rectus abdominis muscle and the epigastric arteries. Surg Gynecol Obstet 110:293–302

    PubMed  CAS  Google Scholar 

  57. Tansatit T, Chokrungvaranont P, Sanguansit P, Wanidchaphloi S (2006) Neurovascular anatomy of the deep inferior epigastric perforator flap for breast reconstruction. J Med Assoc Thai 89(10):1630–1640

    PubMed  Google Scholar 

  58. Ohjimi H, Era K, Fujita T, Tanaka T, Yabuuchi R (2005) Analyzing the vascular architecture of the free TRAM flap using intraoperative ex vivo angiography. Plast Reconstr Surg 116(1):106–113

    Article  PubMed  CAS  Google Scholar 

  59. Ohjimi H, Era K, Tanahashi S, Kawano K, Manabe T, Naitoh M (2002) Ex vivo intraoperative angiography for rectus abdominis musculocutaneous free flaps. Plast Reconstr Surg 109(7):2247–2256

    Article  PubMed  Google Scholar 

  60. Itoh Y, Arai K (1993) The deep inferior epigastric artery free skin flap: anatomic study and clinical application. Plast Reconstr Surg 91(5):853–863

    Article  PubMed  CAS  Google Scholar 

  61. El-Mrakby HH, Milner RH (2002) The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches. Plast Reconstr Surg 109(2):539–543

    Article  PubMed  Google Scholar 

  62. Rozen WM, Palmer KP, Suami H, Pan WR, Ashton MW, Corlett RJ, Taylor GI (2008) The DIEA branching pattern and its relationship to perforators: the importance of preoperative computed tomographic angiography for DIEA perforator flaps. Plast Reconstr Surg 121(2):367–373

    Article  PubMed  CAS  Google Scholar 

  63. Heitmann C, Felmerer G, Durmus C, Matejic B, Ingianni G (2000) Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap. Br J Plast Surg 53(3):205–208

    Article  PubMed  CAS  Google Scholar 

  64. Kikuchi N, Murakami G, Kashiwa H, Homma K, Sato TJ, Ogino T (2001) Morphometrical study of the arterial perforators of the deep inferior epigastric perforator flap. Surg Radiol Anat 23(6):375–381

    Article  PubMed  CAS  Google Scholar 

  65. Rozen WM, Ashton MW, Pan WR, Taylor GI (2007) Raising perforator flaps for breast reconstruction: the intramuscular anatomy of the deep inferior epigastric artery. Plast Reconstr Surg 120(6):1443–1449

    Article  PubMed  CAS  Google Scholar 

  66. Rozen WM, Ashton MW, Taylor GI (2008) Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat 21(2):89–98

    Article  PubMed  CAS  Google Scholar 

  67. Rozen WM, Ashton MW, Le Roux CM, Pan WR, Corlett RJ (2010) The perforator angiosome: a new concept in the design of deep inferior epigastric artery perforator flaps for breast reconstruction. Microsurgery 30(1):1–7

    PubMed  Google Scholar 

  68. Hyakusoku H, Gao JH (1994) The “super-thin” flap. Br J Plast Surg 47(7):457–464

    Article  PubMed  CAS  Google Scholar 

  69. Rozen WM, Grinsell D, Koshima I, Ashton MW (2010) Dominance between angiosome and perforator territories: a new anatomical model for the design of perforator flaps. J Reconstr Microsurg 26(8):539–545

    Article  PubMed  Google Scholar 

  70. Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI (2008) Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 121(1):9–16

    PubMed  CAS  Google Scholar 

  71. Munhoz AM, Ishida LH, Sturtz GP, Cunha MS, Montag E, Saito FL, Gemperli R, Ferreira MC (2004) Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting. Plast Reconstr Surg 113(2):517–524

    Article  PubMed  Google Scholar 

  72. Shoaib T, Marucci D (2006) Adjacent angiosomes instead of zones II and III: reply to “Perfusion zones of the DIEP flap revisited–a clinical study”. Plast Reconstr Surg 118(3):817–818

    Article  PubMed  CAS  Google Scholar 

  73. English JM, Tittle BJ, Barton FE (1994) Breast cancer, cancer prophylaxis, and breast reconstruction. Select Readings Plast Surg 29:1–36

    Google Scholar 

  74. Dinner MI, Dowden RV, Scheflan M (1983) Refinements in the use of the transverse abdominal island flap for postmastectomy reconstruction. Ann Plast Surg 11(5):362–372

    Article  PubMed  CAS  Google Scholar 

  75. Hallock GG (2001) Physiological studies using laser Doppler flowmetry to compare blood flow to the zones of the free TRAM flap. Ann Plast Surg 47(3):229–233

    Article  PubMed  CAS  Google Scholar 

  76. Holm C, Mayr M, Hofter E, Ninkovic M (2006) Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 117(1):37–43

    Article  PubMed  CAS  Google Scholar 

  77. Yamaguchi S, De Lorenzi F, Petit JY, Rietjens M, Garusi C, Giraldo A, Rey PC, Urban C, Martella S, Bosco R (2004) The “perfusion map” of the unipedicled TRAM flap to reduce postoperative partial necrosis. Ann Plast Surg 53(3):205–209

    Article  PubMed  Google Scholar 

  78. Keller A (2006) Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 118(4):1076–1077

    Article  PubMed  CAS  Google Scholar 

  79. Tregaskiss A (2006) Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 118(3):816

    Article  PubMed  CAS  Google Scholar 

  80. Carramenha MA, Carriquiry e Costa C, Vasconez LO, Grotting JC, Herrera RH, Windle BH (1987) An anatomic study of the venous drainage of the transverse rectus abdominis musculocutaneous flap. Plast Reconstr Surg 79(2):208–217

    Article  Google Scholar 

  81. Taylor GI, Caddy CM, Watterson PA, Crock JG (1990) The venous territories (venosomes) of the human body: experimental study and clinical implications. Plast Reconstr Surg 86(2):185–213

    Article  PubMed  CAS  Google Scholar 

  82. Blondeel PN, Arnstein M, Verstraete K, Depuydt K, Van Landuyt KH, Monstrey SJ, Kroll SS (2000) Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 106(6):1295–1299

    Article  PubMed  CAS  Google Scholar 

  83. Wechselberger G, Schoeller T, Bauer T, Ninkovic M, Otto A, Ninkovic M (2001) Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction. Plast Reconstr Surg 108(1):162–166

    Article  PubMed  CAS  Google Scholar 

  84. Hadad I, Ibrahim AM, Lin SJ, Lee BT (2013) Augmented SIEA flap for microvascular breast reconstruction after prior ligation of bilateral deep inferior epigastric arteries. J Plast Reconstr Aesthet Surg 66(6):845–847

    Article  PubMed  Google Scholar 

  85. Spiegel AJ, Khan FN (2007) An Intraoperative algorithm for use of the SIEA flap for breast reconstruction. Plast Reconstr Surg 120(6):1450–1459

    Article  PubMed  CAS  Google Scholar 

  86. Rozen WM, Chubb D, Grinsell D, Ashton MW (2010) The variability of the superficial inferior epigastric artery (SIEA) and its angiosome: a clinical anatomical study. Microsurgery 30(5):386–391

    PubMed  Google Scholar 

  87. Gregoric M, Flis V, Milotic F, Mrda B, Stirn B, Arnez ZM (2011) Delaying the superficial inferior epigastric artery flap: a solution to the problem of the small calibre of the donor artery. J Plast Reconstr Aesthet Surg 64(9):1181–1186

    Article  PubMed  Google Scholar 

  88. Shaw WW (1998) Superior gluteal free flap breast reconstruction. Clin Plast Surg 25(2):267–274

    PubMed  CAS  Google Scholar 

  89. Codner MA, Nahai F (1994) The gluteal free flap breast reconstruction. Making it work. Clin Plast Surg 21(2):289–296

    PubMed  CAS  Google Scholar 

  90. Allen RJ, Tucker C Jr (1995) Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 95(7):1207–1212

    Article  PubMed  CAS  Google Scholar 

  91. Weiler-Mithoff E, Hodgson EL, Malata CM (2002) Perforator flap breast reconstruction. Breast Dis 16:93–106

    PubMed  Google Scholar 

  92. Allen RJ, Haddock NT, Ahn CY, Sadeghi A (2012) Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 129(1):16e–23e

    Article  PubMed  CAS  Google Scholar 

  93. Serletti JM, Moran SL (1998) The combined use of the TRAM and expanders/implants in breast reconstruction. Ann Plast Surg 40(5):510–514

    Article  PubMed  CAS  Google Scholar 

  94. Spear SL, Wolfe AJ (2002) The coincidence of TRAM flaps and prostheses in the setting of breast reconstruction. Plast Reconstr Surg 110(2):478–486

    Article  PubMed  Google Scholar 

  95. Moran SL, Herceg S, Kurtelawicz K, Serletti JM (2000) TRAM flap breast reconstruction with expanders and implants. AORN J 71(2):354–362

    Article  PubMed  CAS  Google Scholar 

  96. Figus A, Canu V, Iwuagwu FC, Ramakrishnan V (2009) DIEP flap with implant: a further option in optimising breast reconstruction. J Plast Reconstr Aesthet Surg 62(9):1118–1126

    Article  PubMed  Google Scholar 

  97. Roehl KR, Baumann DP, Chevray PM, Chang DW (2010) Evaluation of outcomes in breast reconstructions combining lower abdominal free flaps and permanent implants. Plast Reconstr Surg 126(2):349–357

    Article  PubMed  CAS  Google Scholar 

  98. Moore TS, Farrell LD (1992) Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg 89(4):666–672

    Article  PubMed  CAS  Google Scholar 

  99. Kronowitz SJ, Robb GL, Youssef A, Reece G, Chang SH, Koutz CA, Ng RL, Lipa JE, Miller MJ (2003) Optimizing autologous breast reconstruction in thin patients. Plast Reconstr Surg 112(7):1768–1778

    Article  PubMed  Google Scholar 

  100. Figus A, Fioramonti P, Ramakrishnan V (2007) Stacked free SIEA/DIEP flap for unilateral breast reconstruction in a thin patient with an abdominal vertical midline scar. J Reconstr Microsurg 23(8):523–525

    Article  PubMed  Google Scholar 

  101. Pennington DG, Nettle WJ, Lam P (1993) Microvascular augmentation of the blood supply of the contralateral side of the free transverse rectus abdominis musculocutaneous flap. Ann Plast Surg 31(2):123–126

    Article  PubMed  CAS  Google Scholar 

  102. Blondeel PN, Boeckx WD (1994) Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 47(7):495–501

    Article  PubMed  CAS  Google Scholar 

  103. Ali RS, Garrido A, Ramakrishnan V (2002) Stacked free hemi-DIEP flaps: a method of autologous breast reconstruction in a patient with midline abdominal scarring. Br J Plast Surg 55(4):351–353

    Article  PubMed  CAS  Google Scholar 

  104. Schoeller T, Wechselberger G, Roger J, Hussl H, Huemer GM (2007) Management of infraumbilical vertical scars in DIEP-flaps by crossover anastomosis. J Plast Reconstr Aesthet Surg 60(5):524–528

    Article  PubMed  Google Scholar 

  105. DellaCroce FJ, Sullivan SK, Trahan C (2011) Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg 127(3):1093–1099

    Article  PubMed  CAS  Google Scholar 

  106. Shafighi M, Constantinescu MA, Huemer GM, Olariu R, Bonel HM, Banic A, Ramakrishnan V (2013) The extended DIEP flap: extending the possibilities for breast reconstruction with tissue from the lower abdomen. Microsurgery 33(1):24–31

    Article  PubMed  Google Scholar 

  107. Rozen WM, Murray AC, Ashton MW, Bloom RJ, Stella DL, Phillips TJ, Taylor GI (2009) The cutaneous course of deep inferior epigastric perforators: implications for flap thinning. J Plast Reconstr Aesthet Surg 62(8):986–990

    Article  PubMed  CAS  Google Scholar 

  108. Rozen WM, Ashton MW, Taylor GI (2013) Re: the extended diep flap: extending the possibilities for breast reconstruction with tissue from the lower abdomen. Microsurgery 33(2):166–167

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Monash University Plastic, Surgery Group (Peninsula Clinical School), Peninsula Health, 2 Hastings Road, Frankston, Victoria, 3199, Australia

    Michael P. Chae MBBS, BMedSc & David J. Hunter-Smith MBBS, MPH

  2. St Andrew’s Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK

    Venkat Ramakrishnan MS

  3. Monash University Plastic, Surgery Group (Peninsula Clinical School), Peninsula Health, 2 Hastings Road, Frankston, Victoria, 3199, Australia

    Warren M. Rozen MBBS, BMedSc, M.D., Ph.D.

  4. Department of Surgery, School of Medicine and Dentistry, James Cook University Clinical School, Level 1, Townsville Hospital, Douglas, QLD, 4814, Australia

    Warren M. Rozen MBBS, BMedSc, M.D., Ph.D.

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  1. Michael P. Chae MBBS, BMedSc
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  2. Venkat Ramakrishnan MS
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  3. David J. Hunter-Smith MBBS, MPH
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  4. Warren M. Rozen MBBS, BMedSc, M.D., Ph.D.
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Correspondence to Michael P. Chae MBBS, BMedSc .

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  1. Tustin, California, USA

    Melvin A. Shiffman

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Chae, M.P., Ramakrishnan, V., Hunter-Smith, D.J., Rozen, W.M. (2016). The Extended Diep Flap. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_76

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