Arch Aesthetic Plast Surg.  2019 Jan;25(1):9-15. 10.14730/aaps.2019.25.1.9.

Unilateral pedicled transverse rectus abdominis musculocutaneous flap and unilateral free deep inferior epigastric artery perforator flap as a surgical alternative in bilateral autologous breast reconstruction

Affiliations
  • 1Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. nicekek@korea.com
  • 2Department of Plastic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
  • 3Department of Plastic Surgery, Boryeong Asan Hospital, Boryeong, Korea.

Abstract

BACKGROUND
Bilateral microsurgical autologous reconstruction is known to increase operating time, costs, and complications compared to unilateral procedures. This study aimed to determine whether a unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap and a unilateral deep inferior epigastric artery perforator (DIEP) free flap could be a feasible option for bilateral reconstruction in selected circumstances.
METHODS
A retrospective chart review identified patients who underwent unilateral pedicled TRAM and unilateral DIEP reconstruction for bilateral breast reconstruction between 2011 and 2014. Surgical outcomes, complications, and aesthetic scale questionnaire responses were evaluated.
RESULTS
Fourteen patients were included in this study. Ten patients received bilateral immediate reconstruction, while four patients with a previous history of mastectomy underwent unilateral immediate reconstruction and contralateral delayed reconstruction. All flaps survived without any major complications. A case of nipple-areolar skin necrosis on the pedicled TRAM side and a case of mild abdominal bulging at the free DIEP donor site were reported. There was no partial flap necrosis or palpable fat necrosis. On the aesthetic outcome scale, the free DIEP flaps scored significantly higher than did the pedicled TRAM flaps for overall shape, the upper medial and lower lateral quadrant, and the lateral chest wall.
CONCLUSIONS
Our findings suggest that a unilateral pedicled TRAM flap together with a unilateral free DIEP flap could be performed as a bridging surgical option as institutions move toward bilateral free-flap reconstructions, as a way to reduce operating time and the risk of microsurgery-related complications with acceptable donor site morbidity and aesthetic outcomes.

Keyword

Mammaplasty; Myocutaneous flap; Perforator flap; Mastectomy

MeSH Terms

Breast*
Epigastric Arteries*
Fat Necrosis
Female
Free Tissue Flaps
Humans
Mammaplasty*
Mastectomy
Myocutaneous Flap*
Necrosis
Perforator Flap*
Rectus Abdominis*
Retrospective Studies
Skin
Thoracic Wall
Tissue Donors
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