Breast Reconstruction with the Neurotized Deep Inferior Epigastric Perforator Flap

Abstract

Aside from existing advantages for reconstruction of an amputated breast with a free versus a pedicled TRAM-flap, small parts of the rectus abdominis muscle still must be sacrificed to secure blood perfusion of the flap. The deep inferior epigastric perforator flap (DIEP-flap) was recently introduced to overcome this disadvantage in autogenous breast reconstruction. Morbidity of the donor site should be minimized, since this technique avoids fascia or muscle defects. Eight patients underwent ten autogenous breast reconstructions with a DIEP-flap. Four flaps were performed for immediate and six flaps for delayed reconstructions. The internal thoracic artery and vein were used as recipient vessels in seven cases, the thoracodorsal vessels were utilized in three cases. The average operating time was 4.5 hours for unilateral and 6.9 hours for bilateral reconstructions. Two flaps developed total flap necrosis. One was due to a technical error during dissection, another flap developed an arterial thrombosis on postoperative day 5. The remaining flaps healed without problems. Subjectively, patients had far less complaints about the donor site in the lower abdomen compared to a free TRAM- flap, suggesting a lower morbidity in this area with the DIEP-flap.