Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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The Bipedicle-Conjoined Deep Inferior Epigastric Perforator Flap for Unilateral and Bilateral Breast Reconstruction: A Concept in Evolution
Pieter G. Koolen, MD1, Bernard T. Lee, MD, MBA1, Samuel J. Lin, MD1, Heather Erhard, MD2, David T. Greenspun, MD, MSc3.
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, 2Albert Einstein College of Medicine, Bronx, NY, USA, 3Greenwich Hospital, Greenwich, CT, USA.

PURPOSE:
For some patients, single-pedicle deep inferior epigastric perforator artery (DIEP) flaps do not adequately satisfy one or more critical components necessary to achieve an aesthetically satisfactory breast reconstruction; namely restoration of the “footprint”, “conus” and “skin envelope”(1). Satisfying all three elements is particularly challenging when abdominal tissue is relatively scant in the distribution of a single-pedicle DIEP flap and/or when healthy breast skin is deficient. We have found that bipedicle-conjoined abdominal flaps reliably produce aesthetically satisfactory breast reconstructions for women in whom single-pedicle DIEP flap reconstruction would be aesthetically inadequate.
METHODS:
We retrospectively reviewed our 2-year experience with bipedicle-conjoined DIEP flaps (DIEP+DIEP) for unilateral breast reconstruction (25 patients) and our experience using bilateral-conjoined abdominal perforator flaps (DIEP+DCIA or DIEP+SIEA) for bilateral reconstruction (3 patients). In each reconstruction, one DIEP flap (“primary flap”) was anastomosed to the anterograde internal mammary vessels and the second (“conjoined”) flap was anastomosed to either a side branch of the primary flap pedicle or to the retrograde internal mammary vessels.
RESULTS:
Mean age and BMI were 50.0±8.0 years and 25.8±2.9 kg/m2 respectively. Fifteen patients (53.6%) had radiotherapy prior to autologous reconstruction. There were no flap losses; fat necrosis occurred in 6 flaps (20.7%). The large contiguous skin island of the bipedicle-conjoined flaps allowed for extensive replacement of damaged or absent breast skin. Aesthetically satisfactory results were achieved in all patients (Figures 1, 2).
CONCLUSION:
Bipedicle-conjoined abdominal flaps solve a number of aesthetic challenges in autologous breast reconstruction and have several important advantages over single-pedicle flaps. The shape and volume of bipedicle-conjoined abdominal flaps, in combination with their large skin islands, allow significant freedom in the aesthetic sculpting of a breast reconstruction. Bipedicle-conjoined flaps are an excellent option when single-pedicle flaps will not adequately address the critical elements_ footprint, conus and skin envelope_needed to achieve an aesthetically satisfactory breast reconstruction.
Reference:
1. Blondeel PN, Hijjawi J, Depypere H, Roche N, Van Landuyt K. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part II--Breast reconstruction after total mastectomy. Plast Reconstr Surg. 2009 Mar;123(3):794-805


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