Unilateral Internal Mammary Recipient Vessels for Bilateral DIEP Flap Breast Reconstruction

Lee, Jeffrey H.; Varon, David E.; Halvorson, Eric G.

doi:10.1097/gox.0000000000001359

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Two prior reports of cross-chest anastomosis used anterograde and retrograde IM arteries in end-to-end fashion for arterial supply to each flap. 2 , 3 This is supported by previous publications demonstrating the reliability of the retrograde limb of the IM artery for DIEP flap recipient. 17 In both reports, third rib cartilage was removed to microvascular anastomoses, thus limiting the cosmetic benefit of this technique.…”

Section: Discussionsupporting

confidence: 79%

“…In breast cancer reconstruction, some authors have used cross-chest tunnel for flap recipient vessels in cases with poor contralateral vessel viability or in preservation of the left internal mammary (IM) artery for patients at risk of coronary artery disease. 2 – 4 Recently, Satake et al published their experience of cross-chest abdominal flap for contralateral breast augmentation in 32 patients who underwent unilateral breast reconstruction with a DIEP flap and simultaneous augmentation of the contralateral breast using a superficial inferior epigastric artery (SIEA) flap. 5 Reports on microvascular breast augmentation as an alternative for patients with failed breast prostheses are limited due to the complex and costly nature.…”

Section: Introductionmentioning

confidence: 99%

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Use of Single-recipient Vessels for Cross-chest Abdominal Flap–based Breast Augmentation as an Outpatient

Deramo

Martínez²,

Boutros³

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reconstruction with autologous tissue following mastectomy for breast cancer has become the standard of care. Microvascular breast augmentation is an alternative for patients with failed breast prostheses, including painful capsular contractures or poor cosmetic outcomes. We present a series of 4 patients who underwent microvascular breast augmentation with cross-chest flap recipient vessels. Methods: We perform a bilateral DIEP flap reconstruction in an outpatient setting following a modified recovery protocol, focused on decreasing postoperative pain and narcotic requirements, allowing early ambulation and discharge. This includes harvest of the flap via abdominal microfascial incisions and rib-sparing vessel dissection. Cosmetic microvascular augmentation of the contralateral breast was performed via cross-chest flap recipient vessel anastomoses, where the pedicle was tunneled across the chest and anastomosed to the primary flap. Results: Four patients underwent flap-based breast augmentation with cross-chest recipient vessels. Two patients underwent immediate DIEP flap breast reconstruction of the affected side and contralateral flap-based augmentation, while 2 patients underwent bilateral breast augmentation with DIEP flaps for cosmetic purposes due to undesired cosmetic results following implant-based augmentations. No intraoperative complications were reported, and all patients were discharged within 23 hours without signs of flap compromise or need for operative take-backs. Mean follow-up was 23 weeks. Conclusions: The DIEP flap is recognized as an option for breast augmentation, although its limitations are several, including the pain and recovery associated with autologous tissue-based breast reconstruction. Enhanced recovery protocols help reduce this burden, making it more acceptable and feasible.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Use of Single-recipient Vessels for Cross-chest Abdominal Flap–based Breast Augmentation as an Outpatient

Deramo

Martínez²,

Boutros³

2020

Plastic and Reconstructive Surgery - Global Open

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“…13 With this concept of retrograde set of IM vessels utilization, bilateral breast reconstruction was performed in two cases using single-sided recipient vessels where opposite-sided pedicle of DIEP was tuned in subcutaneous plane across the sternum and was anastomosed with retrograde set of IM vessels. 14 Another study done in 250 free flaps for bilateral breast reconstruction using single set of IM vessels by Opsomer et al documented the adequacy of retrograde limb without any significant predisposition of flap failure utilizing the same. 15 Retrograde limb of IM vessels is an invaluable option as second set of donor vessels and adequacy of venous flow can be justified by its valveless system.…”

Section: Discussionmentioning

confidence: 99%

Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle

Jaiswal

Mathews

Gupta

et al. 2022

Indian J Plast Surg

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Introduction The aim of this study is to assess the results of retrograde flow of internal mammary artery and vein (IMA/V) as a donor vessel for free flap microvascular anastomosis (MVA). This need arises with bipedicle deep inferior epigastric perforator (DIEP) flaps, when all four zones with extra fat need to be harvested for unilateral breast reconstruction coupled with poor midline crossover of circulation naturally or because of midline scar. Large anterolateral thigh flaps for chest wall cover, with multiple perforators from separate pedicles, also need supercharging. This needs an additional source of donor vessels, antegrade IMA/V being the first one. Materials and Methods Retrospective study of microvascular breast reconstruction using retrograde internal mammary donor vessels. Results Out of 35 cases, 20 cases had distal IMA/V, with retrograde flow, as donor vessel for second set of arterial and venous anastomosis. In two cases, retrograde IMA/V was used for the solitary set of MVA. In remaining 13 cases, either retrograde IMA or V was utilized either as a principal or accessory donor. No flap was lost. Venous and arterial insufficiency happened in one case each, both were salvaged. Two cases developed partial necrosis, needing debridement and suturing. One case developed marginal necrosis. Only one case developed fat necrosis with superadded infection on follow-up. Conclusion Distal end of IMA and IMV on retrograde flow is safe for MVA as an additional or sole pedicle. It is convenient to use being in the same field. It enables preservation of other including thoracodorsal pedicle and latissimus dorsi flap for use in case of a complication or recurrence.

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Successful free flap salvage upon venous congestion in bilateral breast reconstruction using a venous cross‐over bypass: A case report

et al. 2019

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Abdominal free flaps such as the muscle sparing transverse rectus abdominis myocutaneous (ms‐TRAM) or deep inferior epigastric artery perforator (DIEP) flap represent the gold standard in autologous breast reconstruction. We describe a salvage procedure during bilateral free flap breast reconstruction due to insufficient venous drainage using a venous cross‐over bypass. A 54‐year‐old woman with a thrombosis of the left subclavian port‐system in the medical history was elected for simultaneous bilateral breast reconstruction with ms‐TRAM and DIEP flaps. Intraoperatively, a venous congestion of the DIEP flap, which was connected to the left cranial internal mammary vessels, appeared. In the absence of sufficient ipsilateral venous recipient vessels, we performed a salvage procedure requiring a 15 cm small saphenous vein graft and presternal subcutaneous tunneling. The flap vein was anastomosed end‐to‐end with the contralateral caudal internal mammary vein using a coupler system. The postoperative course was uneventful and both flaps survived. We describe the cross‐over venous emergency bypass as a useful tool in unexpected venous thrombosis during bilateral free flap breast reconstruction.

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Unilateral Internal Mammary Recipient Vessels for Bilateral DIEP Flap Breast Reconstruction

Cited by 5 publications

References 21 publications

Use of Single-recipient Vessels for Cross-chest Abdominal Flap–based Breast Augmentation as an Outpatient

Use of Single-recipient Vessels for Cross-chest Abdominal Flap–based Breast Augmentation as an Outpatient

Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle

Successful free flap salvage upon venous congestion in bilateral breast reconstruction using a venous cross‐over bypass: A case report

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