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Stacked Lateral Thigh Perforator Flap as a Novel Option for Autologous Breast Reconstruction

Tessler, Oren M.D., M.B.A.; Guste, John M.D.; Bartow, Matthew J. M.D.; Torabi, Radbeh M.D.; Gimenez, Alejandro B.A.; Patel, Shukan B. B.S.; Matatov, Tim M.D.; Torabi, Rozbeh M.D.; St. Hilaire, Hugo M.D., D.D.S.; Allen, Bob M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1601-1604
doi: 10.1097/PRS.0000000000005670
Breast: Ideas and Innovations
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Background: Autologous breast reconstruction using perforator flaps offers excellent outcomes, minimizes donor-site morbidity, and allows for precise donor-site selection. The deep inferior epigastric artery perforator, profunda artery perforator, and gluteal artery perforator flaps along with the stacked flap technique are the most common options. This study reports the first series of the stacked lateral thigh perforator flap.

Methods: A retrospective review of all stacked lateral thigh perforator flaps done by a single group of surgeons was performed. Demographics, flap weights, complications, indications, and surgical technique were tabulated for each patient.

Results: Eight female patients with a history of breast cancer underwent delayed unilateral breast reconstruction with stacked lateral thigh perforator flaps for a total of 16 flaps. Mean patient age, body mass index, flap weight, and stacked flap weight were 47.3 years, 26.2 kg/m2, 333.1 g, and 666.1 g, respectively. Microsurgical revascularization was completed in anterograde and retrograde fashion to the internal mammary vasculature. Flap survival was 100 percent and one subsequent flap revision was performed. Two patients developed a seroma at the donor site. Indications included insufficient abdominal tissue, prominent lateral thigh lipodystrophy, prior abdominal surgery, and failed prior abdominally based autologous reconstruction.

Conclusions: This series demonstrates that the lateral thigh perforator flap is a reliable and effective option for a stacked breast reconstruction. Its ease of harvest (stemming from reliable anatomy), straightforward dissection, and intraoperative positioning make it an appealing flap option. The stacked lateral thigh perforator flap allows the reconstructive surgeon to tailor breast reconstruction to the patient, focusing on body habitus and minimizing morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

New Orleans, La.; and Phoenix, Ariz.

From the Louisiana State University Health Sciences Center–New Orleans and Elite Plastic Surgery.

Received for publication August 24, 2017; accepted October 18, 2018.

Disclosure:None of the authors has a financial interest in any of the products or devices mentioned in this article.

Oren Tessler, M.D., M.B.A., 1542 Tulane Avenue, Room 734, New Orleans, La. 70112, otessl@lsuhsc.edu

Copyright © 2019 by the American Society of Plastic Surgeons