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

Abstract

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.

Abdominoplasty and Breast Augmentation with Outpatient Cosmetic Deep Inferior Epigastric Perforator Flaps

“…There were different donor vessel configurations for the 22 total flaps: 17 were anastomosed to the internal mammary artery in the usual manner, three were anastomosed to the internal mammary artery perforator, and two were anastomosed by means of a cross-chest tunneled pedicle through the chest, which we described in a previous report. 8 No fascia or muscle tissue was taken during flap dissection. Mean operative time was 455 ± 35 minutes (range, 420 to 506).…”

Contralateral internal mammary vessels – a rescue recipient vessels option in breast reconstruction

“…The literature so far presents anastomosis to contralateral IM vessel in cases where this option had been planned [ 16–21 ]. We did not plan to use these vessels preoperatively, but it became possible in view of the simultaneous symmetrisation procedure.…”

“…Other surgeons placed the pedicle in a subcutaneous plane [ 16–22 ]. There is no evidence that it leads to increased venous thrombosis rates.…”

“…Contralateral IM vessels have been used in bilateral breast reconstruction settings, unilateral breast reconstruction with contralateral autologous breast augmentation or bilateral breast augmentation [ 16–22 ]. All these authors planned to use the contralateral IM vessels preoperatively.…”