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Combined Microvascular Breast And Lymphatic Reconstruction With Deep Inferior Epigastric Perforator Flap And Gastroepiploic Vascularized Lymph Node Transfer For Postmastectomy Lymphedema Patients
Samyd S. Bustos, M.D.1, Oscar J. Manrique, M.D., F.A.C.S.1, Mouchammed Agko, M.D.2, Eduardo Figueroa Benites, M.D.3, Maria I. Vargas, M.D.3, Antonio J. Forte, M.D., Ph.D., M.S.4, Pedro Ciudad, M.D., Ph.D.3.
1Mayo Clinic, Rochester, MN, USA, 2Augusta University, Augusta, GA, USA, 3Arzobispo Loayza National Hospital, Lima, Peru, 4Mayo Clinic, Jacksonville, FL, USA.

PURPOSE: The combination of microvascular breast reconstruction (MBR) and vascularized lymph node transfer (VLNT) in a single-stage procedure is a surgical option for women who desire breast reconstruction and postmastectomy lymphedema surgery. In this study, we present a series of patients who underwent simultaneous lymphatic and MBR with the gastroepiploic lymph node transfer (GE-VLNT) and the deep inferior epigastric perforator (DIEP) flap respectively.
METHODS:
Between 2018 and 2019, all consecutive patients diagnosed with lymphedema stage IIb - III International Society of Lymphology who underwent simultaneous MBR with DIEP flap and GE-VLNT were included in this study. Patient demographics, comorbidities, prior radiation therapy, operative characteristics, surgical outcomes and complications were collected and analyzed.
RESULTS: Six patients underwent simultaneous unilateral MBR with DIEP flap and GE-VLNT. The mean age was 48 10.5 years and mean body mass index was 28.2 4.5 kg/m2. The mean circumference reduction rate was 30.0 5.1% (p<0.001). One patient required re-exploration due to venous congestion of the lymph node flap but was successfully salvaged. No complications at the donor or recipient site for the DIEP flap were seen. One patient stage III underwent additional liposuction at 12 months postoperative to improve final results.
CONCLUSION: The combined use of DIEP flap and GE-VLNT flaps in a single-stage procedure is a safe and reliable surgical intervention for patients with postmastectomy lymphedema who desire and are suitable for autologous microvascular breast and lymphatic reconstruction.


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