Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps

Nicholas T. Haddock, Thomas M. Suszynski, Sumeet S. Teotia

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: Multiple perforator flap breast reconstruction is an option that avoids implants in selected patients with minimal donor tissue. The technique addresses the need for additional skin to help create a breast envelope with more natural ptosis and additional volume to help create a body-appropriate breast mound while avoiding serial fat grafting. Using four flaps for the reconstruction of two breasts (bilateral stacked flap reconstruction) has recently become feasible with the advancement of microsurgical techniques, increased experience with alternative perforator flaps, and use of co-surgery. In this article, we describe our early experience with bilateral stacked flap breast reconstruction.

METHODS: From January of 2014 to October of 2018, the senior co-surgeons performed 50 consecutive bilateral stacked flap operations at a single institution. All reconstructions were performed in delayed fashion with a mean operative time of 10 hours. Most breasts (94 percent) were reconstructed with a deep inferior epigastric perforator flap combined with a profunda artery perforator flap. Most flap microanastomoses (91.5 percent) were performed directly with internal mammary vessels. The larger of the two flaps was typically placed inferiorly (66 percent), but there was significant inset variability.

RESULTS: Of 200 flaps, five were lost (2.5 percent). Seven take-backs were needed for a flap-related concern, which included two negative explorations and a flap salvage. The most common non-flap-related complication was a thigh wound (17 total, eight requiring a procedure).

CONCLUSION: The authors' early experience suggests that bilateral stacked flap breast reconstruction is a powerful tool that can be performed with an acceptable microsurgical risk and an acceptable complication profile in highly selected patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish (US)
Pages (from-to)294-303
Number of pages10
JournalPlastic and reconstructive surgery
Volume147
Issue number2
DOIs
StatePublished - Feb 1 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2020 by the American Society of Plastic Surgeons.

Keywords

  • Abdominal Wall/blood supply
  • Adult
  • Breast/surgery
  • Breast Neoplasms/surgery
  • Female
  • Free Tissue Flaps/blood supply
  • Humans
  • Mammaplasty/adverse effects
  • Mastectomy/adverse effects
  • Microsurgery/adverse effects
  • Middle Aged
  • Operative Time
  • Perforator Flap/blood supply
  • Postoperative Complications/epidemiology
  • Retrospective Studies
  • Thigh/blood supply
  • Treatment Outcome

PubMed: MeSH publication types

  • Journal Article

Fingerprint

Dive into the research topics of 'Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps'. Together they form a unique fingerprint.

Cite this