by Opsomer,
Dries; D’Arpa, Salvatore; Benmeridja, Lara; Stillaert, Filip; Noel, Warren; Van
Landuyt, Koenraad
Background: The deep inferior epigastric artery perforator (DIEP) flap is
considered the gold standard in autologous breast reconstruction. In bilateral
cases, both flaps are often anastomosed to the internal mammary vessels on
either side of the sternum. The authors propose a method in which both flaps
are anastomosed to only the right side internal mammary artery and vein.
Methods: Between November of 2009 and March of 2018, 125 patients underwent
bilateral DIEP flap breast reconstruction with this technique. One flap is
perfused by the anterograde proximal internal mammary artery and the second one
by the retrograde distal internal mammary artery after presternal tunneling.
Patient demographics and operative details were reviewed retrospectively. Results: Two hundred fifty flaps were
performed. One hundred fifty-two flaps were prophylactic or primary
reconstructions (60.8 percent), 70 were secondary reconstructions (28 percent),
and 28 were tertiary reconstructions (11.2 percent). Mean patient age was 46
years, and the mean body mass index was 25 kg/m2. Sixty patients underwent
radiation therapy or chemotherapy (48 percent). The authors encountered one
significant partial failure (0.4 percent) and nine complete flap failures (3.6
percent). The authors did not see a statistically significant predisposition
for failure comparing the retrograde with the anterograde flow flaps, nor when
comparing the tunneled with the nontunneled flaps.
Conclusions: The authors’ results show that anastomosing
both DIEP flaps to a single set of mammary vessels is safe and reliable. The
authors conclude that the retrograde flow through the distal internal mammary
artery is sufficient for free flap perfusion and that subcutaneous tunneling of
a free flap pedicle does not predispose to flap failure. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
