Application of dual-pedicle abdominal flap for unilateral breast reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Guangxue ,  MU Lan , YANG Kai , PENG Zhe , LIU Yan , BI Ye , ZHU Yi , WANG Cai , WANG Yi , ZANG Huiran , CAO Saisai , ZHANG Peiyang

Department of Plastic and Reconstructive Surgery, Peking University People’s Hospital, Beijing, 100044, P.R.China;

Corresponding author：

MU Lan, Email: mulan666@aliyun.com

Keywords：

Breast reconstruction; dual-pedicle flap; abdominal flap

DOI：

10.7507/1002-1892.201807043

Video：

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Objective To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction.Methods Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly.Results Vascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up.Conclusion The dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.

Citation： LI Guangxue, MU Lan, YANG Kai, PENG Zhe, LIU Yan, BI Ye, ZHU Yi, WANG Cai, WANG Yi, ZANG Huiran, CAO Saisai, ZHANG Peiyang. Application of dual-pedicle abdominal flap for unilateral breast reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 70-74. doi: 10.7507/1002-1892.201807043 Copy

1.	Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
2.	Haddock NT, Gassman A, Cho MJ, et al. 101 consecutive profunda artery perforator flaps in breast reconstruction: lessons learned with our early experience. Plast Reconstr Surg, 2017, 140(2): 229-239.
3.	Peters KT, Blondeel PN, Lobo F, et al. Early experience with the free lumbar artery perforator flap for breast reconstruction. J Plast Reconstr Aesthet Surg, 2015, 68(8): 1112-1119.
4.	Hunter JE, Lardi AM, Dower DR, et al. Evolution from the TUG to PAP flap for breast reconstruction: Comparison and refinements of technique. J Plast Reconstr Aesthet Surg, 2015, 68(7): 960-965.
5.	Mayo JL, Allen RJ, Sadeghi A. Four-flap breast reconstruction: bilateral stacked DIEP and PAP flaps. Plast Reconstr Surg Glob Open, 2015, 3(5): e383.
6.	Hamdi M, Craggs B, Brussaard C, et al. Lumbar artery perforator flap: An anatomical study using multidetector computed tomographic scan and surgical pearls for breast reconstruction. Plast Reconstr Surg, 2016, 138(2): 343-352.
7.	Ciudad P, Maruccia M, Orfaniotis G, et al. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction. Microsurgery, 2015, 36(5): 359-366.
8.	Allen RJ Jr, Lee ZH, Mayo JL, et al. The profunda artery perforator flap experience for breast reconstruction. Plast Reconstr Surg, 2016, 138(5): 968-975.
9.	Lee BT, Agarwal JP, Ascherman JA, et al. Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg, 2017, 140(5): 651e-664e.
10.	Salgarello M, Visconti G, Barone-Adesi L, et al. Contralateral breast symmetrisation in immediate prosthetic breast reconstruction after unilateral nipple-sparing mastectomy: the tailored reduction/augmentation mammaplasty. Arch Plast Surg, 2015, 42(3): 302-308.
11.	Wade RG, Marongiu F, Sassoon EM, et al. Contralateral breast symmetrisation in unilateral DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(10): 1363-1373.
12.	Minqiang X, Lanhua M, Jie L, et al. The value of mutidector row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps. Br J Radiol, 2010, 83(985): 40-43.
13.	Losken A, Zenn MR, Hammel JA, et al. Assessment of zonal perfusion using intraoperative angiography during abdominal flap breast reconstruction. Plast Reconstr Surg, 2012, 129(4): 618e-624e.
14.	Lhuaire M, Hivelin M, Dramé M, et al. Determining the best recipient vessel site for autologous microsurgical breast reconstruction with DIEP flaps: An anatomical study. J Plast Reconstr Aesthet Surg, 2017, 70(6): 781-791.
15.	Mu L, Yan Y, Li S, et al. Transparent morphology of the thoracoabdominal wall. J Reconstr Microsurg, 2001, 17(8): 611-614.
16.	穆兰花, 李森恺, 李养群, 等. 横向游离腹直肌肌皮瓣与胸廓内动脉吻合的乳房再造术. 中华整形烧伤杂志, 1997, 13(2): 100-101.
17.	Lanhua Mu, Jun Xu, Yuanbo Liu, et al. Breast reconstruction with free bipedicled TRAM or DIEP flaps by anastomosis to the proximal and distal ends of the internal mammary vessels. Seminars in Plastic Surgery, 2002, 16(1): 61-68.
18.	穆兰花, 徐军, 刘元波, 等. 以双蒂腹壁下动脉穿支皮瓣再造乳房. 中华显微外科杂志, 2003, 26(3): 223-224.
19.	Chen R, Mu L, Zhang H, et al. Simultaneous breast reconstruction and treatment of breast cancer related upper arm lymphedema with lymphatic lower abdominal flap. Ann Plast Surg, 2014, 73(Suppl 1): S12-17.
20.	穆籣, 毕晔, 彭喆, 等. 自体组织乳房再造及胸壁修复同期行吻合血管淋巴结组织移植及淋巴管静脉吻合治疗乳腺癌术后腋窝凹陷畸形及上肢淋巴水肿. 中华整形外科杂志, 2017, 33(增刊): 54-60.
21.	Stalder MW, Lam J, Allen RJ, et al. Using the retrograde internal mammary system for stacked perforator flap breast reconstruction: 71 breast reconstructions in 53 consecutive patients. Plast Reconstr Surg, 2016, 137(2): 265e-277e.
22.	Salgarello M, Visconti G, Barone-Adesi L, et al. The retrograde limb of internal mammary vessels as reliable recipient vessels in DIEP flap breast reconstruction: a clinical and radiological study. Ann Plast Surg, 2015, 74(4): 447-453.
23.	Kosutic D, Lambe GF. The use of single recipient internal mammary vessels for bilateral diep flap breast reconstruction in a recipient-vessel-depleted patient. Microsurgery, 2018, 38(1): 120-121.
24.	Tyrell R, Leong RY, Sathyanarayana SA, et al. Using a single internal mammary artery as retrograde and antegrade flow for bilateral deep inferior epigastric artery perforator reconstruction: A case report. Int J Angiol, 2016, 25(5): e87-e88.
25.	Rozen WM, Patel NG, Craggs BS, et al. Four-flap breast reconstruction with bilateral stacked flaps. Plast Reconstr Surg, 2016, 137(2): 492e-493e.
26.	Angrigiani C, Rancati A, Artero G, et al. Stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. Plast Reconstr Surg, 2016, 138(6): 969e-972e.
27.	Rozen WM, Patel NG, Ramakrishnan VV. Increasing options in autologous microsurgical breast reconstruction: four free flaps for ‘stacked’ bilateral breast reconstruction. Gland Surg, 2016, 5(2): 255-260.
28.	穆籣, 彭喆, 毕晔, 等. 双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习. 中华显微外科杂志, 2016, 39(6): 555-558.

1. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
2. Haddock NT, Gassman A, Cho MJ, et al. 101 consecutive profunda artery perforator flaps in breast reconstruction: lessons learned with our early experience. Plast Reconstr Surg, 2017, 140(2): 229-239.
3. Peters KT, Blondeel PN, Lobo F, et al. Early experience with the free lumbar artery perforator flap for breast reconstruction. J Plast Reconstr Aesthet Surg, 2015, 68(8): 1112-1119.
4. Hunter JE, Lardi AM, Dower DR, et al. Evolution from the TUG to PAP flap for breast reconstruction: Comparison and refinements of technique. J Plast Reconstr Aesthet Surg, 2015, 68(7): 960-965.
5. Mayo JL, Allen RJ, Sadeghi A. Four-flap breast reconstruction: bilateral stacked DIEP and PAP flaps. Plast Reconstr Surg Glob Open, 2015, 3(5): e383.
6. Hamdi M, Craggs B, Brussaard C, et al. Lumbar artery perforator flap: An anatomical study using multidetector computed tomographic scan and surgical pearls for breast reconstruction. Plast Reconstr Surg, 2016, 138(2): 343-352.
7. Ciudad P, Maruccia M, Orfaniotis G, et al. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction. Microsurgery, 2015, 36(5): 359-366.
8. Allen RJ Jr, Lee ZH, Mayo JL, et al. The profunda artery perforator flap experience for breast reconstruction. Plast Reconstr Surg, 2016, 138(5): 968-975.
9. Lee BT, Agarwal JP, Ascherman JA, et al. Evidence-based clinical practice guideline: autologous breast reconstruction with DIEP or pedicled TRAM abdominal flaps. Plast Reconstr Surg, 2017, 140(5): 651e-664e.
10. Salgarello M, Visconti G, Barone-Adesi L, et al. Contralateral breast symmetrisation in immediate prosthetic breast reconstruction after unilateral nipple-sparing mastectomy: the tailored reduction/augmentation mammaplasty. Arch Plast Surg, 2015, 42(3): 302-308.
11. Wade RG, Marongiu F, Sassoon EM, et al. Contralateral breast symmetrisation in unilateral DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(10): 1363-1373.
12. Minqiang X, Lanhua M, Jie L, et al. The value of mutidector row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps. Br J Radiol, 2010, 83(985): 40-43.
13. Losken A, Zenn MR, Hammel JA, et al. Assessment of zonal perfusion using intraoperative angiography during abdominal flap breast reconstruction. Plast Reconstr Surg, 2012, 129(4): 618e-624e.
14. Lhuaire M, Hivelin M, Dramé M, et al. Determining the best recipient vessel site for autologous microsurgical breast reconstruction with DIEP flaps: An anatomical study. J Plast Reconstr Aesthet Surg, 2017, 70(6): 781-791.
15. Mu L, Yan Y, Li S, et al. Transparent morphology of the thoracoabdominal wall. J Reconstr Microsurg, 2001, 17(8): 611-614.
16. 穆兰花, 李森恺, 李养群, 等. 横向游离腹直肌肌皮瓣与胸廓内动脉吻合的乳房再造术. 中华整形烧伤杂志, 1997, 13(2): 100-101.
17. Lanhua Mu, Jun Xu, Yuanbo Liu, et al. Breast reconstruction with free bipedicled TRAM or DIEP flaps by anastomosis to the proximal and distal ends of the internal mammary vessels. Seminars in Plastic Surgery, 2002, 16(1): 61-68.
18. 穆兰花, 徐军, 刘元波, 等. 以双蒂腹壁下动脉穿支皮瓣再造乳房. 中华显微外科杂志, 2003, 26(3): 223-224.
19. Chen R, Mu L, Zhang H, et al. Simultaneous breast reconstruction and treatment of breast cancer related upper arm lymphedema with lymphatic lower abdominal flap. Ann Plast Surg, 2014, 73(Suppl 1): S12-17.
20. 穆籣, 毕晔, 彭喆, 等. 自体组织乳房再造及胸壁修复同期行吻合血管淋巴结组织移植及淋巴管静脉吻合治疗乳腺癌术后腋窝凹陷畸形及上肢淋巴水肿. 中华整形外科杂志, 2017, 33(增刊): 54-60.
21. Stalder MW, Lam J, Allen RJ, et al. Using the retrograde internal mammary system for stacked perforator flap breast reconstruction: 71 breast reconstructions in 53 consecutive patients. Plast Reconstr Surg, 2016, 137(2): 265e-277e.
22. Salgarello M, Visconti G, Barone-Adesi L, et al. The retrograde limb of internal mammary vessels as reliable recipient vessels in DIEP flap breast reconstruction: a clinical and radiological study. Ann Plast Surg, 2015, 74(4): 447-453.
23. Kosutic D, Lambe GF. The use of single recipient internal mammary vessels for bilateral diep flap breast reconstruction in a recipient-vessel-depleted patient. Microsurgery, 2018, 38(1): 120-121.
24. Tyrell R, Leong RY, Sathyanarayana SA, et al. Using a single internal mammary artery as retrograde and antegrade flow for bilateral deep inferior epigastric artery perforator reconstruction: A case report. Int J Angiol, 2016, 25(5): e87-e88.
25. Rozen WM, Patel NG, Craggs BS, et al. Four-flap breast reconstruction with bilateral stacked flaps. Plast Reconstr Surg, 2016, 137(2): 492e-493e.
26. Angrigiani C, Rancati A, Artero G, et al. Stacked thoracodorsal artery perforator flaps for unilateral breast reconstruction. Plast Reconstr Surg, 2016, 138(6): 969e-972e.
27. Rozen WM, Patel NG, Ramakrishnan VV. Increasing options in autologous microsurgical breast reconstruction: four free flaps for ‘stacked’ bilateral breast reconstruction. Gland Surg, 2016, 5(2): 255-260.
28. 穆籣, 彭喆, 毕晔, 等. 双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习. 中华显微外科杂志, 2016, 39(6): 555-558.

Chinese Journal of Reparative and Reconstructive Surgery

Application of dual-pedicle abdominal flap for unilateral breast reconstruction

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