Abstract
Breast reconstruction after modified radical mastectomy is always a challenge for plastic surgeons. The widespread use of free flaps and especially the use of the DIEP flap, which is considered the “Gold Standard” (Blondeel 1999), made the choice about the preferred reconstruction method easier.
Challenging cases include slim patients (BMI near the low end of the natural range), with the contralateral healthy breast of medium volume or more (cup size ≥ B) and without ptosis. If the patient does not need or want any operation on the healthy breast, achieving the desirable esthetic outcome and symmetry needs to be attended with caution. The objectives are to ensure symmetry with a well-vascularized flap, avoiding complications at the donor site from over resection.
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References
Anker AM, Prantl L, Strauss C, Brébant V, Heine N, Lamby P, Geis S, Schenkhoff F, Pawlik M, Klein SM. Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction – a randomized controlled trial. Clin Hemorheol Microcirc. 2018;69(1–2):37–44. https://doi.org/10.3233/CH-189129. PMID: 29660924.
Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg. 1999;52(2):104–11. https://doi.org/10.1054/bjps.1998.3033. PMID: 10434888.
Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part II – breast reconstruction after total mastectomy. Plast Reconstr Surg. 2009;123(3):794–805. https://doi.org/10.1097/PRS.0b013e318199ef16. PMID: 19319042.
Chen K, Beeraka NM, Sinelnikov MY, Zhang J, Song D, Gu Y, Li J, Reshetov IV, Startseva OI, Liu J, Fan R, Lu P. Patient management strategies in perioperative, intraoperative, and postoperative period in breast reconstruction with DIEP-Flap: clinical recommendations. Front Surg. 2022;9:729181. https://doi.org/10.3389/fsurg.2022.729181. PMID: 35242802; PMCID: PMC8887567.
Fitzgerald O’Connor E, Rozen WM, Chowdhry M, Band B, Ramakrishnan VV, Griffiths M. Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications. Gland Surg. 2016;5(2):93–8. https://doi.org/10.3978/j.issn.2227-684X.2015.05.17. PMID: 27047777; PMCID: PMC4791353.
Haddock NT, Cho MJ, Teotia SS. Comparative analysis of single versus stacked free flap breast reconstruction: a single-center experience. Plast Reconstr Surg. 2019;144(3):369e–77e. https://doi.org/10.1097/PRS.0000000000005906. PMID: 31461004.
Hembd AS, Yan J, Zhu H, Haddock NT, Teotia SS. Intraoperative assessment of DIEP flap breast reconstruction using indocyanine green angiography: reduction of fat necrosis, resection volumes, and postoperative surveillance. Plast Reconstr Surg. 2020;146(1):1e–10e. https://doi.org/10.1097/PRS.0000000000006888. PMID: 32590635.
Kantak NA, Koolen PG, Martin C, Tobias AM, Lee BT, Lin SJ. Are patients with low body mass index candidates for deep inferior epigastric perforator flaps for unilateral breast reconstruction? Microsurgery. 2015;35(6):421–7. https://doi.org/10.1002/micr.22407. Epub 2015 Mar 28. PMID: 25821046.
Kiely J, Kumar M, Wade RG. The accuracy of different modalities of perforator mapping for unilateral DIEP flap breast reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2021;74(5):945–56. https://doi.org/10.1016/j.bjps.2020.12.005. Epub 2020 Dec 10. PMID: 33342741.
Xu H, Dong J, Wang T. Bipedicle deep inferior epigastric perforator flap for unilateral breast reconstruction: seven years’ experience. Plast Reconstr Surg. 2009;124(6):1797–807. https://doi.org/10.1097/PRS.0b013e3181bf81cf. PMID: 19952636.
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Balitsaris, E., Venizelos, V., Gravvanis, A. (2022). DIEP Flap Reconstruction in a Slim Patient. In: Gravvanis, A., Kakagia, D.D., Ramakrishnan, V. (eds) Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-23706-6_74
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DOI: https://doi.org/10.1007/978-3-030-23706-6_74
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