by Haddock, Nicholas T.; Suszynski, Thomas M.; Teotia,
Sumeet S.
Plastic and
Reconstructive Surgery: February 2021
- Volume 147 - Issue 2 - p 294-303
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.
