J Korean Med Assoc.  2011 Jan;54(1):35-43.

Breast reconstruction using deep inferior epigastric artery perforator flap

• Kim JT
• Kim YH

Abstract

Breast reconstruction with autologous tissue has been generally accepted as a reliable procedure, the preferred donor site being lower abdominal tissue. To sacrifice the minimal amount of muscle tissue and to reduce donor site morbidity, the concept of a perforator flap was applied to the fields of breast reconstruction, such as the deep inferior epigastric artery perforator (DIEAp) flap. The DIEAp flap provides essentially the same soft tissue components as the transverse rectus abdominis muscle (TRAM) flap while significantly reducing harvesting of the rectus muscle from the abdominal wall, thereby minimizing donor site morbidity; which includes abdominal weakness, hernia, and postoperative pain, with decreased recovery time. However, there are some concerns about the tedious and risky dissection of intramuscular perforators, and the variable vascularity of the flap supplied by tiny perforators. According to our novel flap harvesting techniques, using bipolar electrocauterization for intramuscular dissection is useful in preventing injury to the tiny perforators. Including some fibers of rectus muscle and soft tissue without full isolation and skeletonization around the pedicles is also useful for prevention of vascular injury and intraoperative vessel spasms. Moreover, the flap must include 2 to 3 reliable perforators, regardless of lateral or medial rows, for prevention of postoperative fat necrosis. The superficial inferior epigastric vein can provide additional venous drainage. These surgical tips can aid in overcoming the pitfalls of the DIEA perforator flap in breast reconstruction. The DIEAp flap is an excellent choice for breast reconstruction. According to our experience, it has been shown to be a safe and reliable method for providing good results and patient satisfaction with minimal donor morbidity in breast reconstruction.

Keyword

Breast reconstruction; Deep inferior epigastric artery; Perforator

MeSH Terms

Abdominal Wall
Breast
Drainage
Epigastric Arteries
Ethylamines
Fat Necrosis
Female
Glycosaminoglycans
Hernia
Humans
Mammaplasty
Muscles
Pain, Postoperative
Patient Satisfaction
Perforator Flap
Rectus Abdominis
Skeleton
Spasm
Tissue Donors
Vascular System Injuries
Veins
Ethylamines
Glycosaminoglycans

Figure

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  Figure 1 Evolution of flap concept. The conventional flap was based on source vessel (blue dots) and it has been advanced to the branch (red dots) and finally to the perforator-based concept (green dots). Therefore, more selective tissues are harvested to preserve more tissues in donor site. P, perforator.

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  Figure 2 Comparison of conventional bulky transverse rectus abdominis muscle flap (A) and deep inferior epigastric artery perforator flap based on perforators (B).

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  Figure 3 Several perforator are shown thorough rectus fascia and most reliable one is selected as a pedicle. P, perforator.

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  Figure 4 Immediate breast reconstruction with deep inferior epigastric artery perforator flap.

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  Figure 5 Delayed breast reconstruction with deep inferior epigastric artery perforator flap.

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