Breast Reconstruction Perforator Flaps

Excerpt

Among women, breast cancer is the most commonly diagnosed cancer after non-melanoma skin cancer. It is presented as the second cause of cancer deaths after lung cancer. In 2020, 42,170 women in the United States are expected to die from breast cancer (U.S . Breast cancer statistics)

Despite advanced breast conservation techniques due to advances in immunotherapy and hormone therapy for local control of disease, not all patients are good candidates for these techniques. Many patients require a mastectomy, both for the treatment of breast cancer and prophylactically for those with cancer genes.

Plastic surgery offers two reconstruction methods; implant reconstruction and autologous reconstruction. Factors influencing these methods include the size and shape of the breast that is being rebuilt, the woman’s age and health, her history of past surgeries, surgical risk factors (for example, smoking history and obesity), the availability of autologous tissue, and the location of the tumor in the breast.

Two types of autologous reconstruction techniques can be described: vascularized pedicled skin/muscle flaps (latissimus dorsi flap, TRAM flap) or free flaps (deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, Gluteal artery perforator (GAP) flaps, and profunda artery perforator flap).

Introduced by Holmstrom and Robbins, the deep inferior epigastric perforator flap (DIEP) is an aesthetic and better-accepted technique for autologous microsurgical breast reconstruction after mastectomy for breast cancer.

For breast reconstruction without sacrificing the rectus abdominis muscle, The first clinical use of skin and fatty tissue was reported by Koshima and Soeda and was then practiced by Allen and Treece and has become the benchmark for breast reconstruction but requires significant microsurgical experience to harvest.

The popularity has arisen because the use of the perforators and blood vessels only eliminates much of the significant morbidity to the abdominal wall and rectus musculature associated with the traditional transverse rectus abdominis myocutaneous (TRAM) flap.

Breast reconstruction with DIEP flap ensures satisfactory long-term results in most patients because, in these procedures, the consistency of the reconstructed breast is almost identical to that of the natural breast in terms of softness and aesthetics and especially with the evolution of genetics, autologous breast reconstruction is becoming increasingly important especially in light of the increased rates of prophylactic mastectomies with BRCA mutations.