Lumbar Flap versus the Gold Standard: Comparison to the DIEP Flap

Opsomer, Dries; Vyncke, Tom; Depypere, Bernard; Stillaert, Filip; Blondeel, Phillip; Landuyt, Koenraad Van

doi:10.1097/prs.0000000000006681

Cited by 31 publications

(49 citation statements)

References 18 publications

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“…A similar percentage (54%; 163/300) of patients received lipofilling in the present study collective. In a study including 408 DIEP flaps and 56 LAP flaps, Opsomer et al stated the need for later lipofilling to be 39% in LAP and 64% in their DIEP flaps [34]. The exact numbers regarding the indication of secondary surgeries including lipofilling are highly variable and depend on multiple factors though such as patient satisfaction, demand, and the individual local health care provider.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to other popular and most commonly used alternatives to the DIEP flap for autologous breast reconstruction such as the lumbar artery perforator (LAP) flap, the superior gluteal artery perforator (SGAP) flap or the fasciocutaneous infragluteal free flap (FCI) flap, the TMG flap offers a comparable size and a similar complication profile, the mean pedicle length is significantly shorter though [36][37][38]. An overview of the common used free flaps and their detailed characteristics is shown in Table 5 [21,23,34,39,40]. Other observed donor site complications include a widening and caudal migration of the scar which can easily be corrected with scar revision and suture fixation to the deep fascia or the periost of the ischial tuberosity.…”

Section: Discussionmentioning

confidence: 99%

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Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Weitgasser

Mahrhofer

Schwaiger

et al. 2021

JCM

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Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. Patients and Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Weitgasser

Mahrhofer

Schwaiger

et al. 2021

JCM

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“…Free flap from the abdomen requires a certain volume which is not always present in young women with BRCA mutation. An alternative is the lumbar artery perforator flap which is possible also in very thin patients ([ 145 , 146 ]). The transverse myocutaneous gracilis free flap is a third alternative, and this procedure is more suitable for women with small and medium sized breasts and not enough abdominal bulk for a regular DIEP [ 147 ].…”

Section: Surgical Procedures Associated With Female With Brca Mutationmentioning

confidence: 99%

Management of patients with BRCA mutation from the point of view of a breast surgeon

Riis

2021

Annals of Medicine &Amp; Surgery

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Germ-line mutation in BRCA (BReast CAncer gene) 1 or BRCA2 are found in 3–4% of all women with breast cancer. These patients have a significant increased risk of breast and ovarian cancer. They are often younger when diagnosed with the mutation, and the possible breast cancer they get is often aggressive with inferior outcome. There are risk reducing strategies, and the most powerful strategy is risk reducing surgery, both risk reducing bilateral mastectomy (RRM) and risk reducing bilateral salpino-oophorectomy (PBSO). This review is meant to address breast surgery in patients with germline BRCA mutation. The guidelines and techniques applied is under continuous change and it is important for the clinicians to be well informed to provide the patient with the information needed for them to make an informed decision on what risk strategy to choose.

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“…3 We found that patient satisfaction with breasts after a LAP flap reconstruction is similarly high to the satisfaction reported by DIEP flap patients, and that considerable volumes of fat can be harvested even in slender women. 3 The difficulties of the flap are its technical difficulty and the fact that bilateral reconstructions are staged. This translates into more takebacks and a higher failure rate.…”

mentioning

confidence: 53%

“…Skin-island positioning on the flank has been optimized to keep the scars low and horizontal over the iliac crest (►Fig. [2][3][4].…”

Section: Surgical Techniquementioning

confidence: 99%

Donor Site Morbidity after Lumbar Artery Perforator Flap Breast Reconstruction

Opsomer

Vyncke

Ryx

et al. 2021

J Reconstr Microsurg

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Background The lumbar artery perforator flap is a second-choice flap in autologous breast reconstruction whenever a deep inferior epigastric artery perforator (DIEP) flap is not possible. Ideal candidates are pear-shaped women who do not have enough bulk on the abdomen or thighs. Patient-reported “satisfaction with breasts” is excellent but we were curious about the donor site morbidity. Methods We performed a retrospective study of all lumbar flap breast reconstructions performed between 2010 and 2019. Patients were invited by e-mail and telephone to take part in a BREAST-Q survey. Results One hundred fifty-four flaps were performed in 110 patients. Sixty-three patients filled out the BREAST-Q questionnaire. The most frequently observed donor site complications are seroma (35.1%), dehiscence (8.4%), and hematoma (3.2%). Correction of the donor site scar was performed in 31.8% of patients, lipofilling of the donor flank in 5.2%, and liposuction of the contralateral flank in 18.3% of patients. Body mass index (BMI) was the only significant risk factor for donor site complications. Patient-reported “satisfaction with donor site appearance” was good but significantly lower for primary reconstructions compared with secondary and tertiary procedures. Flap weight significantly influences patient-reported “physical wellbeing of the donor site.” Ninety-seven percent of patients would recommend the surgery to someone in a similar position and would do it all over. Conclusion The lumbar artery perforator flap is a good alternative for breast reconstruction in selected patients. The donor site issues consist mainly of seromas, prolonged discomfort, and a scar that might be noticeable to others, but patient-reported satisfaction is very high.

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Lumbar Flap versus the Gold Standard: Comparison to the DIEP Flap

Cited by 31 publications

References 18 publications

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Management of patients with BRCA mutation from the point of view of a breast surgeon

Donor Site Morbidity after Lumbar Artery Perforator Flap Breast Reconstruction

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