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Review
. 2022 Dec 19;36(4):253-259.
doi: 10.1055/s-0042-1759573. eCollection 2022 Nov.

Microsurgical Breast Reconstruction: Maximizing Success

Rudolf Buntic  1 , Alexander Y Li  2
Affiliations
Review

Microsurgical Breast Reconstruction: Maximizing Success

Rudolf Buntic et al. Semin Plast Surg. .

Abstract

Breast reconstruction is becoming increasingly recognized as a fundamental component in comprehensive breast cancer treatment. The primary goal for any reconstruction is to safely restore a natural appearing breast. When it comes to achieving the elements of size, shape, symmetry, and softness, the use of autologous tissue has many advantages. The approach to autologous breast reconstruction has changed substantially over the years as microsurgical free tissue transplants become more routine and accessible. While a variety of flap donor sites exist, careful flap selection based on surgical history and the availability of donor tissue is critical in achieving reliable results. This article reviews the clinical considerations in patient evaluation, donor site selection, and surgical approach taken at the Buncke Clinic.

Keywords: DIEP; PAP; SGAP; TUG; autologous breast reconstruction; breast reconstruction.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
The outline of the deep inferior epigastric artery perforator (DIEP) flap on the abdomen. The major perforators on the flap are marked on the abdomen with red dots. The superficial inferior epigastric vein (SIEV) and superficial inferior epigastric artery (SIEA) are also marked after identifying with the pencil Doppler. Since a large volume is not needed in this unilateral reconstruction, the upper flap incision is placed quite low.
Fig. 2
Fig. 2
The right-sided deep inferior epigastric artery perforator (DIEP) flap is brought up to the contralateral chest and deepithelialized and shaped. The DIEP vessels are anastomosed to the internal mammary vessels and the superficial inferior epigastric vein (SIEV) is drained into a branch of the subscapular venous system.
Fig. 3
Fig. 3
( A ) The superficial inferior epigastric vein (SIEV) is traced and dissected inferiorly toward its origin (yellow arrow). ( B ) The SIEV has been divided.
Fig. 4
Fig. 4
The axillary is approached via the mastectomy incision, as shown, or as a separate incision if necessary, and a serratus branch vein is identified here (yellow arrow).
Fig. 5
Fig. 5
The transverse upper gracilis (TUG) flap markings on the inner thigh. Red markings indicate Doppler signals.
Fig. 6
Fig. 6
( A ) The transverse upper gracilis (TUG) flap isolated. ( B ) The posterior branch of the saphenous vein can be incorporated for augmenting venous drainage if necessary.
See this image and copyright information in PMC

References

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