Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2013; 40(01): 3-10
DOI: 10.5999/aps.2013.40.1.3
Review Article

Autologous Microvascular Breast Reconstruction

Claragh Healy
St. Andrew's Centre for Burns and Plastics, Broomfield Hospital, Chelmsford, UK
,
Venkat Ramakrishnan
St. Andrew's Centre for Burns and Plastics, Broomfield Hospital, Chelmsford, UK
› Author Affiliations
› Further Information
   Permissions and Reprints

Autologous microvascular breast reconstruction is widely accepted as a key component of breast cancer treatment. There are two basic donor sites; the anterior abdominal wall and the thigh/buttock region. Each of these regions provides for a number of flaps that are successfully utilised in breast reconstruction. Refinement of surgical technique and the drive towards minimising donor site morbidity whilst maximising flap vascularity in breast reconstruction has seen an evolution towards perforator based flap reconstructions, however myocutaneous flaps are still commonly practiced. We review herein the current methods of autologous microvascular breast reconstruction.

Keywords

Free tissue flaps - Mammaplasty - Mastectomy


Publication History

Received: 09 March 2012

Accepted: 11 August 2012

Article published online:
01 May 2022

© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 2009; 124: 395-408
    CrossrefPubMedGoogle Scholar
  • 2 Atisha D, Alderman AK, Lowery JC. et al. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg 2008; 247: 1019-1028
    CrossrefPubMedGoogle Scholar
  • 3 Fernandez-Delgado J, Lopez-Pedraza MJ, Blasco JA. et al. Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Ann Oncol 2008; 19: 1430-1434
    CrossrefPubMedGoogle Scholar
  • 4 Rogers NE, Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 2002; 109: 1919-1924
    CrossrefPubMedGoogle Scholar
  • 5 Makmur L, Lim J, Lim TC. Radiation therapy in immediate breast reconstruction with DIEP flap. Plast Reconstr Surg 2003; 112: 920-921
    CrossrefPubMedGoogle Scholar
  • 6 Massey MF, Spiegel AJ, Levine JL. et al. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Plast Reconstr Surg 2009; 124: 737-751
    CrossrefPubMedGoogle Scholar
  • 7 Holmström H. The free abdominoplasty flap and its use in breast reconstruction: An experimental study and clinical case report. Scand J Plast Reconstr Surg 1979; 13: 423-427
    CrossrefPubMedGoogle Scholar
  • 8 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645-648
    CrossrefPubMedGoogle Scholar
  • 9 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: 32-38
    CrossrefPubMedGoogle Scholar
  • 10 Moon HK, Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 1988; 82: 815-832
    CrossrefPubMedGoogle Scholar
  • 11 Rozen WM, Ashton MW, Grinsell D. The branching pattern of the deep inferior epigastric artery revisited in-vivo: a new classification based on CT angiography. Clin Anat 2010; 23: 87-92
    PubMedGoogle Scholar
  • 12 Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69: 216-225
    CrossrefPubMedGoogle Scholar
  • 13 Holm C, Mayr M, Hofter E. et al. Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 2006; 117: 37-43
    CrossrefPubMedGoogle Scholar
  • 14 Rozen WM, Ashton MW, Le Roux CM. et al. The perforator angiosome: a new concept in the design of deep inferior epigastric artery perforator flaps for breast reconstruction. Microsurgery 2010; 30: 1-7
    CrossrefPubMedGoogle Scholar
  • 15 Wong C, Saint-Cyr M, Mojallal A. et al. Perforasomes of the DIEP flap: vascular anatomy of the lateral versus medial row perforators and clinical implications. Plast Reconstr Surg 2010; 125: 772-782
    CrossrefPubMedGoogle Scholar
  • 16 Rozen WM, Ashton MW, Murray AC. et al. Avoiding denervation of rectus abdominis in DIEP flap harvest: the importance of medial row perforators. Plast Reconstr Surg 2008; 122: 710-716
    CrossrefPubMedGoogle Scholar
  • 17 Blondeel PN. Discussion: Perfusion-related complications are similar for DIEP and muscle-sparing free TRAM flaps harvested on medial or lateral deep inferior epigastric artery branch perforators for breast reconstruction. Plast Reconstr Surg 2011; 128: 590e-592e
    CrossrefPubMedGoogle Scholar
  • 18 Rubino C, Ramakrishnan V, Figus A. et al. Flap size/flow rate relationship in perforator flaps and its importance in DIEAP flap drainage. J Plast Reconstr Aesthet Surg 2009; 62: 1666-1670
    CrossrefPubMedGoogle Scholar
  • 19 Hijjawi JB, Blondeel PN. Advancing deep inferior epigastric artery perforator flap breast reconstruction through multidetector row computed tomography: an evolution in preoperative imaging. J Reconstr Microsurg 2010; 26: 11-20
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Masia J, Navarro C, Clavero JA. et al. Noncontrast magnetic resonance imaging for preoperative perforator mapping. Clin Plast Surg 2011; 38: 253-261
    CrossrefPubMedGoogle Scholar
  • 21 Ali RS, Garrido A, Ramakrishnan V. Stacked free hemi-DIEP flaps: a method of autologous breast reconstruction in a patient with midline abdominal scarring. Br J Plast Surg 2002; 55: 351-353
    CrossrefPubMedGoogle Scholar
  • 22 Blondeel PN, Boeckx WD. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 1994; 47: 495-501
    CrossrefPubMedGoogle Scholar
  • 23 Agarwal JP, Gottlieb LJ. Double pedicle deep inferior epigastric perforator/muscle-sparing TRAM flaps for unilateral breast reconstruction. Ann Plast Surg 2007; 58: 359-363
    CrossrefPubMedGoogle Scholar
  • 24 Dellacroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg 2011; 127: 1093-1099
    CrossrefPubMedGoogle Scholar
  • 25 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52: 104-111
    CrossrefPubMedGoogle Scholar
  • 26 Granzow JW, Levine JL, Chiu ES. et al. Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 2006; 59: 571-579
    CrossrefPubMedGoogle Scholar
  • 27 De Frene B, Van Landuyt K, Hamdi M. et al. Free DIEAP and SGAP flap breast reconstruction after abdominal/gluteal liposuction. J Plast Reconstr Aesthet Surg 2006; 59: 1031-1036
    CrossrefPubMedGoogle Scholar
  • 28 Shayan R, Rozen WM, Bernard S. et al. Perforator dilatation induced by body weight gain is not reversed by subsequent weight loss: implications for perforator flaps. Plast Reconstr Surg 2008; 122: 1765-1772
    CrossrefPubMedGoogle Scholar
  • 29 Man LX, Selber JC, Serletti JM. Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review. Plast Reconstr Surg 2009; 124: 752-764
    CrossrefPubMedGoogle Scholar
  • 30 Selber JC, Bergey M, Sonnad SS. et al. Free flap breast reconstruction in advanced age: is it safe?. Plast Reconstr Surg 2009; 124: 1015-1022
    CrossrefPubMedGoogle Scholar
  • 31 Antia NH, Buch VI. Transfer of an abdominal dermo-fat graft by direct anastomosis of blood vessels. Br J Plast Surg 1971; 24: 15-19
    CrossrefPubMedGoogle Scholar
  • 32 Grotting JC. The free abdominoplasty flap for immediate breast reconstruction. Ann Plast Surg 1991; 27: 351-354
    CrossrefPubMedGoogle Scholar
  • 33 Rozen WM, Chubb D, Grinsell D. et al. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery 2010; 30: 386-391
    CrossrefPubMedGoogle Scholar
  • 34 Spiegel AJ, Khan FN. An Intraoperative algorithm for use of the SIEA flap for breast reconstruction. Plast Reconstr Surg 2007; 120: 1450-1459
    CrossrefPubMedGoogle Scholar
  • 35 Hartrampf Jr CR, Noel RT, Drazan L. et al. Ruben's fat pad for breast reconstruction: a peri-iliac soft-tissue free flap. Plast Reconstr Surg 1994; 93: 402-407
    CrossrefPubMedGoogle Scholar
  • 36 Gardner PM, Grotting JC. In: Strauch B, Vasconez LO, Hall-Findlay EH. et al. Rubens flap for breast reconstruction. Grabb's encyclopedia of flaps; torso, pelvis and lower extremities. 2009. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1075-1077
    Google Scholar
  • 37 Allen RJ, Haddock NT, Ahn CY. et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 2012; 129: 16e-23e
    CrossrefPubMedGoogle Scholar
  • 38 Fujino T, Harasina T, Aoyagi F. Reconstruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock. Plast Reconstr Surg 1975; 56: 178-181
    CrossrefPubMedGoogle Scholar
  • 39 Le-Quang C. Secondary microsurgical reconstruction of the breast and free inferior gluteal flap. Ann Chir Plast Esthet 1992; 37: 723-741
    PubMedGoogle Scholar
  • 40 Tuinder S, Chen CM, Massey MF. et al. Introducing the septocutaneous gluteal artery perforator flap: a simplified approach to microsurgical breast reconstruction. Plast Reconstr Surg 2011; 127: 489-495
    CrossrefPubMedGoogle Scholar
  • 41 Allen RJ. The superior gluteal artery perforator flap. Clin Plast Surg 1998; 25: 293-302
    CrossrefPubMedGoogle Scholar
  • 42 Allen RJ, Levine JL, Granzow JW. The in-the-crease inferior gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg 2006; 118: 333-339
    CrossrefPubMedGoogle Scholar
  • 43 Allen RJ, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995; 95: 1207-1212
    CrossrefPubMedGoogle Scholar
  • 44 Granzow JW, Levine JL, Chiu ES. et al. Breast reconstruction with gluteal artery perforator flaps. J Plast Reconstr Aesthet Surg 2006; 59: 614-621
    CrossrefPubMedGoogle Scholar
  • 45 LoTempio MM, Allen RJ. Breast reconstruction with SGAP and IGAP flaps. Plast Reconstr Surg 2010; 126: 393-401
    CrossrefPubMedGoogle Scholar
  • 46 Schoeller T, Wechselberger G. Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg 2004; 57: 481-482
    CrossrefPubMedGoogle Scholar
  • 47 Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 2004; 114: 69-73
    CrossrefPubMedGoogle Scholar
  • 48 Arnez ZM, Pogorelec D, Planinsek F. et al. Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg 2004; 57: 20-26
    CrossrefPubMedGoogle Scholar
  • 49 Yousif NJ, Matloub HS, Kolachalam R. et al. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1992; 29: 482-490
    CrossrefPubMedGoogle Scholar
  • 50 Fattah A, Figus A, Mathur B. et al. The transverse myocutaneous gracilis flap: technical refinements. J Plast Reconstr Aesthet Surg 2010; 63: 305-313
    CrossrefPubMedGoogle Scholar
  • 51 Schoeller T, Huemer GM, Wechselberger G. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection. Plast Reconstr Surg 2008; 122: 29-38
    CrossrefPubMedGoogle Scholar
  • 52 Fansa H, Schirmer S, Warnecke IC. et al. The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction. Plast Reconstr Surg 2008; 122: 1326-1333
    CrossrefPubMedGoogle Scholar
  • 53 Hallock GG. Further experience with the medial circumflex femoral (GRACILIS) perforator free flap. J Reconstr Microsurg 2004; 20: 115-122
    Article in Thieme ConnectPubMedGoogle Scholar