Autologous Microvascular Breast Reconstruction

Claragh Healy; Venkat Ramakrishnan

doi:10.5999/aps.2013.40.1.3

Archives of Plastic Surgery, Table of Contents

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

Authors

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

Abstract

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

Full Text

References

REFERENCES
1 Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 2009; 124: 395-408
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
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
4 Rogers NE, Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 2002; 109: 1919-1924
5 Makmur L, Lim J, Lim TC. Radiation therapy in immediate breast reconstruction with DIEP flap. Plast Reconstr Surg 2003; 112: 920-921
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
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
8 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645-648
9 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: 32-38
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
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
12 Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69: 216-225
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
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
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
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
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
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
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
20 Masia J, Navarro C, Clavero JA. et al. Noncontrast magnetic resonance imaging for preoperative perforator mapping. Clin Plast Surg 2011; 38: 253-261
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
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
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
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
25 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52: 104-111
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
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
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
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
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
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
32 Grotting JC. The free abdominoplasty flap for immediate breast reconstruction. Ann Plast Surg 1991; 27: 351-354
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
34 Spiegel AJ, Khan FN. An Intraoperative algorithm for use of the SIEA flap for breast reconstruction. Plast Reconstr Surg 2007; 120: 1450-1459
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
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
37 Allen RJ, Haddock NT, Ahn CY. et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 2012; 129: 16e-23e
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
39 Le-Quang C. Secondary microsurgical reconstruction of the breast and free inferior gluteal flap. Ann Chir Plast Esthet 1992; 37: 723-741
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
41 Allen RJ. The superior gluteal artery perforator flap. Clin Plast Surg 1998; 25: 293-302
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
43 Allen RJ, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995; 95: 1207-1212
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
45 LoTempio MM, Allen RJ. Breast reconstruction with SGAP and IGAP flaps. Plast Reconstr Surg 2010; 126: 393-401
46 Schoeller T, Wechselberger G. Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg 2004; 57: 481-482
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
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
49 Yousif NJ, Matloub HS, Kolachalam R. et al. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1992; 29: 482-490
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
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
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
53 Hallock GG. Further experience with the medial circumflex femoral (GRACILIS) perforator free flap. J Reconstr Microsurg 2004; 20: 115-122