Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps
| Autor: | Thomas M. Suszynski, Nicholas T. Haddock, Sumeet S. Teotia |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Microsurgery medicine.medical_specialty Mammaplasty Operative Time Breast Neoplasms 030230 surgery Thigh Free Tissue Flaps 03 medical and health sciences Postoperative Complications 0302 clinical medicine Ptosis medicine Humans Breast Mastectomy Retrospective Studies business.industry Abdominal Wall Bilateral breast reconstruction Middle Aged Posterior compartment of thigh eye diseases Surgery Treatment Outcome medicine.anatomical_structure Clinical question 030220 oncology & carcinogenesis Female medicine.symptom business Complication Breast reconstruction Perforator Flap Perforator flaps |
| Zdroj: | Plastic & Reconstructive Surgery. 147:294-303 |
| ISSN: | 0032-1052 |
| Popis: | Background Multiple perforator flap breast reconstruction is an option that avoids implants in selected patients with minimal donor tissue. The technique addresses the need for additional skin to help create a breast envelope with more natural ptosis and additional volume to help create a body-appropriate breast mound while avoiding serial fat grafting. Using four flaps for the reconstruction of two breasts (bilateral stacked flap reconstruction) has recently become feasible with the advancement of microsurgical techniques, increased experience with alternative perforator flaps, and use of co-surgery. In this article, we describe our early experience with bilateral stacked flap breast reconstruction. Methods From January of 2014 to October of 2018, the senior co-surgeons performed 50 consecutive bilateral stacked flap operations at a single institution. All reconstructions were performed in delayed fashion with a mean operative time of 10 hours. Most breasts (94 percent) were reconstructed with a deep inferior epigastric perforator flap combined with a profunda artery perforator flap. Most flap microanastomoses (91.5 percent) were performed directly with internal mammary vessels. The larger of the two flaps was typically placed inferiorly (66 percent), but there was significant inset variability. Results Of 200 flaps, five were lost (2.5 percent). Seven take-backs were needed for a flap-related concern, which included two negative explorations and a flap salvage. The most common non-flap-related complication was a thigh wound (17 total, eight requiring a procedure). Conclusion The authors' early experience suggests that bilateral stacked flap breast reconstruction is a powerful tool that can be performed with an acceptable microsurgical risk and an acceptable complication profile in highly selected patients. Clinical question/level of evidence Therapeutic, IV. |
| Databáze: | OpenAIRE |
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