The Deep Circumflex Iliac Artery Perforator Flap for Breast Reconstruction: Un lambeau perforateur de l’artère iliaque circonflexe profonde pour la reconstruction mammaire

Abstract

Autologous breast reconstruction using abdominal-based perforator flaps produces excellent aesthetic results with minimal donor site morbidity. The superficial inferior epigastric artery and deep inferior epigastric perforator (DIEP) flaps reliably perfuse a hemi-abdomen, up to the anterior axillary line. Beyond this line laterally, the flank or "love handle" tissue is primarily perfused by the deep circumflex iliac artery (DCIA) or secondarily by the superficial circumflex iliac artery. The flank tissue is a valuable addition to increase flap size when harvested with a DIEP flap or to provide vascularized tissue when the abdomen has been previously harvested. Harvesting the flank tissue in combination with the anterior abdominal tissue improves the contour of the trunk, accentuates the waist, and minimizes secondary revisions to excise prominent "dogears." The DCIA flap is a novel technique for breast reconstruction. In this article, we describe our technique, pearls and pitfalls, and early results. Résumé La reconstruction mammaire autologue à l'aide de lambeaux perforateurs abdominaux produit d'excellents résultats esthétiques et une morbidité minimale au siège du donneur. Les lambeaux de l'artèreépigastrique inférieure superficielle et du perforateuŕ epigastrique inférieur profond (PÉIF) perfusent en toute fiabilité un hémi-abdomen, jusqu'à la ligne axillaire antérieure. Au-delà de cette ligne latérale, la perfusion primaire des tissus du flanc, ou de la « poignée d'amour », est d'abord assurée par l'artère iliaque circonflexe profonde (AICP) ou secondairement par l'artère iliaque circonflexe superficielle. Les tissus du flanc sont un ajout précieux à l'accroissement de la dimension du lambeau lorsqu'il est prélevé avec un lambeau du PÉIF ou qu'il vise à fournir des tissus vascularisés après avoirété prélevé dans l'abdomen. Le prélèvement des tissus du flanc en combinaison avec les tissus abdominaux antérieurs améliore le contour du tronc, accentue la taille et réduit les révisions secondaires pour exciser les « oreilles de chien » proéminentes. Le lambeau de l'AICP est une nouvelle technique de reconstruction mammaire. Dans le présent article, les auteurs décrivent leur technique, leurs perles et leursécueils de même que leurs résultats préliminaires.

An extended superficial circumflex iliac artery perforator flap transfer for a relatively‐small breast reconstruction after total mastectomy

“…Unlike a traditional groin flap which is raised in the inguinal region, a SCIP flap is raised in the iliac region around and lateral to the anterior superior iliac spine (ASIS) (Acland, 1979; Koshima et al, 2004; Yamamoto, 2019; Yamamoto et al, 2020). The iliac region usually has thicker soft tissue than the inguinal region, and has been reported useful as a free flap donor site for breast reconstruction (Acland, 1979; Elzinga & Buchel, 2018; Koshima et al, 2004; Yamamoto, 2019). Since elevated distally from the origin of the SCIA, a SCIP flap has a longer pedicle than a groin flap, allowing easier microvascular anastomosis in the axilla with more flexible vessel positioning (Elzinga & Buchel, 2018; Koshima et al, 2004; Yamamoto et al, 2020).…”

“…The iliac region usually has thicker soft tissue than the inguinal region, and has been reported useful as a free flap donor site for breast reconstruction (Acland, 1979; Elzinga & Buchel, 2018; Koshima et al, 2004; Yamamoto, 2019). Since elevated distally from the origin of the SCIA, a SCIP flap has a longer pedicle than a groin flap, allowing easier microvascular anastomosis in the axilla with more flexible vessel positioning (Elzinga & Buchel, 2018; Koshima et al, 2004; Yamamoto et al, 2020). Including the deep branch of the SCIA is necessary to extend SCIP flap volume by including the iliac soft tissue lateral and cranial to the ASIS (Koshima et al, 2004; Yamamoto et al, 2020).…”

“…Heterochronous development of bilateral breast cancer is not uncommon, and future options for the contralateral breast reconstruction should also be considered when unilateral breast reconstruction is scheduled (Elzinga & Buchel, 2018; Jo et al, 2020; Opsomer et al, 2018; Opsomer et al, 2020; Patel & Ramakrishnan, 2020; Satake et al, 2015; Yamamoto, 2019; Yamamoto et al, 2020). For simultaneous bilateral breast reconstruction, bilateral DIEP flap transfer is one of the most favorable method with high success and satisfaction rates (Grünherz et al, 2020; Patel & Ramakrishnan, 2020; Seidenstuecker et al, 2016).…”

“…Autologous tissue breast reconstruction after total mastectomy requires a flap with enough bulk to fulfill a breast defect (Jo et al, 2020; Opsomer et al, 2020; Patel & Ramakrishnan, 2020; Seidenstuecker et al, 2016). Perforator flap transfer has become a choice of reconstructive methods for breast reconstruction (Elzinga & Buchel, 2018; Grünherz et al, 2020; Jo et al, 2020; Opsomer et al, 2018; Opsomer et al, 2020; Satake et al, 2015; Seidenstuecker et al, 2016). Among various perforator flaps, deep inferior epigastric artery perforator (DIEP) flap is the most common and popular (Patel & Ramakrishnan, 2020; Seidenstuecker et al, 2016; Yamamoto et al, 2019).…”

The Conjoined TUGPAP Flap for Breast Reconstruction: Systematic Review and Illustrative Anatomy

“…However, not all women are candidates for DIEP flap reconstruction due to a paucity of abdominal adiposity, previous abdominoplasty, abnormal scarring, or previous DIEP flap harvest. For women seeking autologous reconstruction, alternative options include donor sites from: the trunk, such as the latissimus dorsi (LD), 1 2 lumbar artery perforator (LAP), 2 , 3 and deep circumflex iliac artery (DCIA); 4 , 5 the buttock, such as the superior gluteal artery perforator (SGAP) 6 , 7 and inferior gluteal artery perforator (IGAP); 7 – 9 and the thigh, such as the transverse upper gracilis (TUG), 10 – 16 profunda artery perforator (PAP), 17 – 22 lateral thigh perforator, 23 , 24 and anterolateral thigh (ALT). 25 , 26 …”