by Beugels, Jop;
Vasile, Julie V.; Tuinder, Stefania M. H.; Delatte, Stephen J.; St-Hilaire,
Hugo; Allen, Robert J.; Levine, Joshua L.
Background:
Options for bilateral autologous breast reconstruction in thin women are
limited. The aim of this study was to introduce a novel approach to increase
abdominal flap volume with the stacked hemiabdominal extended perforator
(SHAEP) flap. The authors describe the surgical technique and analyze their
results.
Methods: A
retrospective study was conducted of all SHAEP flap breast reconstructions
performed since February of 2014. Patient demographics, operative details,
complications, and flap reexplorations were recorded. The bipedicled
hemiabdominal flap was designed as a combination of the deep inferior
epigastric artery perforator (DIEP) and a second, more lateral pedicle: the deep
or superficial circumflex iliac perforator vessels, the superficial inferior
epigastric artery, or a lumbar artery or intercostal perforator.
Results: A
total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive
patients. Median operative time was 500 minutes (range, 405 to 797 minutes).
Median hemiabdominal flap weight that was used for reconstruction was 598 g
(range, 160 to 1389 g). No total flap losses were recorded. Recipient-site
complications included partial flap loss (2.2 percent), hematoma (3.3 percent),
fat necrosis (2.2 percent), and wound problems (4.4 percent). Minor donor-site
complications occurred in five patients (10.2 percent). Most flaps were
harvested on a combination of the DIEP and deep circumflex iliac artery vessels.
Conclusions: This
study demonstrated that the SHAEP flap is an excellent option for bilateral
autologous breast reconstruction in women who require significant breast volume
but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled
SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal
contour improvement using a single abdominal donor site. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
