Immediate Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap.

Ryu, Min Hee; Kim, Hyo Heon; Jeong, Jae Ho

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2007;34(2):229-236.
Published online March 1, 2007.

Immediate Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap.

Min Hee Ryu, Hyo Heon Kim, Jae Ho Jeong

Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea. jhjeong@med.yu.ac.kr

Abstract

PURPOSE
Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. METHODS: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system.
RESULTS
Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities.
CONCLUSION
The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.

Keywords: Breast reconstruction; Deep inferior epigastric artery; Perforator flap; Deep inferior epigastric artery flap