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Page 8 of 15 Sarrami et al. Plast Aesthet Res 2024;11:13 https://dx.doi.org/10.20517/2347-9264.2024.06

Figure 8. Preoperative (top row) and postoperative (bottom row) images of right latissimus dorsi flap breast reconstruction with an
implant and harvested lateral thoracic lymph nodes.

ensure a robust lymphatic response when inset in a lymphedematous region .
[5,7]
Technical conisderations
Prior to incision, reverse lymphatic mapping should be implemented to ensure the protection of lymph
[18]
nodes draining the lower extremity . Width and bulk of the flap are dependent on patient body habitus
and can be determined with a pinch test . During flap dissection, a wide margin of adipose tissue should
[33]
[5,7]
be maintained to maximize volume and avoid skeletonizing the lymph nodes . Once the perforator is
identified, it is followed down to the source vessels [Figure 9]. If necessary, opening the deep fascia will help
obtain a longer pedicle with increased luminal diameter . This is helpful during flap inset but increases
[31]
donor site morbidity risks. Ideally, the lymph nodes are positioned in the axilla and anastomosis can be
made to the lateral thoracic or internal mammary vessels [32,33] .

As described by Yano et al., a bipedicle flap based on the SCIP and the superficial inferior epigastric artery
[36]
can also provide a robust reconstructive option without penetrating the deep fascia . In their study, the
flap showed good perfusion over a large territory. Additionally, they preserved the DIEP as an alternative
vascular option [24,36] .

Outcomes
To date, Akita et al. have reported the only use of a chimeric SCIP flap with inguinal nodes for a BCRL
patient requiring partial breast reconstruction . They were able to adequately augment the breast with
[32]
adipose tissue while positioning the skin paddle and lymph nodes in the axilla. At 12 months postop, the
[32]
patient was able to discontinue compression therapy of her arm . Similarly favorable results were found in
the quality-of-life study by De Brucker et al. . Three patients received SCIP flap reconstruction with lymph
[26]
nodes for BCRL treatment; however, the small skin paddle was only included for flap monitoring. At a
follow-up of 12-31 months, patients had improved quality of life scores and discontinued all
physiotherapy . This chimeric flap has shown successful soft tissue and lymphatic reconstruction in the
[26]
upper extremity [Figure 10].

Benefits
The major benefit of the SCIP flap is its minimal donor site morbidity. This surgical option preserves the
deep fascia, preventing abdominal bulges and herniations [33,36] . The donor site scar is also relatively low and
[5,7]
lateral, keeping it well concealed . Additionally, two SCIP flaps can be planned and harvested for bilateral
[33]
breast reconstruction if necessary .