Effect of free deep inferior epigastric artery perforator flap transplantation in breast shaping of two-staged breast reconstruction with vertical scar_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ , TANG Yuanyuan ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , ZHANG Yixin ² , FENG Guang ³ , ZHOU Bo ¹ , LÜ Chunliu ¹ , YI Liang ¹ , LUO Zhenhua ¹ , WANG Zhiyuan ⁴

1. Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, P.R.China;
3. Department of Burn and Plastic Reconstructive Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P.R.China;
4. Ultrasound Diagnosis Center, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Deep inferior epigastric artery perforator flap; flap shaping; breast cancer; breast reconstruction

DOI：

10.7507/1002-1892.202105016

Video：

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Objective To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.Methods The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.Results All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.Conclusion It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.

Citation： SONG Dajiang, TANG Yuanyuan, LI Zan, ZHOU Xiao, ZHANG Yixin, FENG Guang, ZHOU Bo, LÜ Chunliu, YI Liang, LUO Zhenhua, WANG Zhiyuan. Effect of free deep inferior epigastric artery perforator flap transplantation in breast shaping of two-staged breast reconstruction with vertical scar. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1323-1327. doi: 10.7507/1002-1892.202105016 Copy

1.	Healy C, Allen RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 2014, 30(2): 121-125.
2.	Blondeel PN, Hijjawi J, Depypere H, et al. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Plast Reconstr Surg, 2009, 123(2): 455-462.
3.	Blondeel PN, Hijjawi J, Depypere H, et al. 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.
4.	Blondeel PN, Hijjawi J, Depypere H, et al. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part Ⅲ—reconstruction following breast conservative treatment. Plast Reconstr Surg, 2009, 124(1): 28-38.
5.	Blondeel PN, Hijjawi J, Depypere H, et al. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part Ⅳ—aesthetic breast surgery. Plast Reconstr Surg, 2009, 124(2): 372-382.
6.	Dionyssiou D, Demiri E, Tsimponis A, et al. Predesigned breast shaping assisted by multidetector-row computed tomographic angiography in autologous breast reconstruction. Plast Reconstr Surg, 2014, 133(2): 100e-108e.
7.	Nahabedian MY. Achieving ideal breast aesthetics with autologous reconstruction. Gland Surg, 2015, 4(2): 134-144.
8.	Srinivasa DR, Garvey PB, Qi J, et al. Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg, 2017, 140(5): 869-877.
9.	宋达疆, 李赞, 周晓, 等. 股深动脉穿支皮瓣在乳房重建的应用. 中华整形外科杂志, 2017, 33(6): 412-416.
10.	宋达疆, 李赞, 周晓, 等. 游离横行股薄肌肌皮瓣在乳房重建的应用. 中华整形外科杂志, 2019, 35(3): 237-242.
11.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
12.	宋达疆, 李赞, 周晓, 等. 股薄肌皮瓣联合大收肌穿支皮瓣在乳房重建中的应用. 中国修复重建外科杂志, 2018, 32(6): 707-713.
13.	Losken A. Breast reshaping following massive weight loss: principles and techniques. Plast Reconstr Surg, 2010, 126(3): 1075-1085.
14.	Gabbay JS, Eby JB, Kulber DA. The midabdominal TRAM flap for breast reconstruction in morbidly obese patients. Plast Reconstr Surg, 2005, 115(3): 764-770.
15.	Gravvanis A, Smith RW. Shaping the breast in secondary microsurgical breast reconstruction: single- vs. two-esthetic unit reconstruction. Microsurgery, 2010, 30(7): 509-516.
16.	Choi M, Frey JD. Optimizing aesthetic outcomes in breast reconstruction after nipple-sparing mastectomy. Aesthet Surg J, 2020, 40(Suppl 2): S13-S21.

1. Healy C, Allen RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 2014, 30(2): 121-125.
2. Blondeel PN, Hijjawi J, Depypere H, et al. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Plast Reconstr Surg, 2009, 123(2): 455-462.
3. Blondeel PN, Hijjawi J, Depypere H, et al. 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.
4. Blondeel PN, Hijjawi J, Depypere H, et al. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part Ⅲ—reconstruction following breast conservative treatment. Plast Reconstr Surg, 2009, 124(1): 28-38.
5. Blondeel PN, Hijjawi J, Depypere H, et al. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part Ⅳ—aesthetic breast surgery. Plast Reconstr Surg, 2009, 124(2): 372-382.
6. Dionyssiou D, Demiri E, Tsimponis A, et al. Predesigned breast shaping assisted by multidetector-row computed tomographic angiography in autologous breast reconstruction. Plast Reconstr Surg, 2014, 133(2): 100e-108e.
7. Nahabedian MY. Achieving ideal breast aesthetics with autologous reconstruction. Gland Surg, 2015, 4(2): 134-144.
8. Srinivasa DR, Garvey PB, Qi J, et al. Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg, 2017, 140(5): 869-877.
9. 宋达疆, 李赞, 周晓, 等. 股深动脉穿支皮瓣在乳房重建的应用. 中华整形外科杂志, 2017, 33(6): 412-416.
10. 宋达疆, 李赞, 周晓, 等. 游离横行股薄肌肌皮瓣在乳房重建的应用. 中华整形外科杂志, 2019, 35(3): 237-242.
11. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
12. 宋达疆, 李赞, 周晓, 等. 股薄肌皮瓣联合大收肌穿支皮瓣在乳房重建中的应用. 中国修复重建外科杂志, 2018, 32(6): 707-713.
13. Losken A. Breast reshaping following massive weight loss: principles and techniques. Plast Reconstr Surg, 2010, 126(3): 1075-1085.
14. Gabbay JS, Eby JB, Kulber DA. The midabdominal TRAM flap for breast reconstruction in morbidly obese patients. Plast Reconstr Surg, 2005, 115(3): 764-770.
15. Gravvanis A, Smith RW. Shaping the breast in secondary microsurgical breast reconstruction: single- vs. two-esthetic unit reconstruction. Microsurgery, 2010, 30(7): 509-516.
16. Choi M, Frey JD. Optimizing aesthetic outcomes in breast reconstruction after nipple-sparing mastectomy. Aesthet Surg J, 2020, 40(Suppl 2): S13-S21.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of free deep inferior epigastric artery perforator flap transplantation in breast shaping of two-staged breast reconstruction with vertical scar

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