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The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction

Beugels, Jop, M.D.; Vasile, Julie V., M.D.; Tuinder, Stefania M. H., M.D., Ph.D.; Delatte, Stephen J., M.D.; St-Hilaire, Hugo, M.D.; Allen, Robert J., M.D.; Levine, Joshua L., M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1424–1434
doi: 10.1097/PRS.0000000000005058
Breast: Original Articles
Discussion
Coding Perspective

Background: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemiabdominal extended perforator (SHAEP) flap. The authors describe the surgical technique and analyze their results.

Methods: A retrospective study was conducted of all SHAEP flap breast reconstructions performed since February of 2014. Patient demographics, operative details, complications, and flap reexplorations were recorded. The bipedicled hemiabdominal flap was designed as a combination of the deep inferior epigastric artery perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels, the superficial inferior epigastric artery, or a lumbar artery or intercostal perforator.

Results: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range, 405 to 797 minutes). Median hemiabdominal flap weight that was used for reconstruction was 598 g (range, 160 to 1389 g). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2 percent), hematoma (3.3 percent), fat necrosis (2.2 percent), and wound problems (4.4 percent). Minor donor-site complications occurred in five patients (10.2 percent). Most flaps were harvested on a combination of the DIEP and deep circumflex iliac artery vessels.

Conclusions: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for this Article is on Page 1432.

Maastricht, The Netherlands; New York and Mt. Kisco, N.Y.; New Orleans, La.; and Hackensack, N.J.

From the Department of Plastic, Reconstructive and Hand Surgery, and the GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center; the Department of Plastic Surgery, New York Eye and Ear Infirmary at Mt. Sinai; the Division of Plastic Surgery, Northern Westchester Hospital; the Division of Plastic Surgery, Louisiana State University Health Sciences Center; and the Department of Plastic Surgery, Hackensack University Medical Center.

Received for publication January 19, 2018; accepted May 18, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

Joshua L. Levine, M.D., Center for Breast Reconstruction, 3 Columbus Circle, Suite 1410, New York, N.Y. 10019, info@joshualevinemd.com

©2018American Society of Plastic Surgeons