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Farajzadeh et al. Plast Aesthet Res 2024;11:32 Plastic and
DOI: 10.20517/2347-9264.2024.24
Aesthetic Research

Review Open Access

Optimizing perfusion and volume in autologous
breast reconstruction: dual-plane, conjoined and

stacked flaps

Matthew M. Farajzadeh, Ara A. Salibian
Division of Plastic & Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
Correspondence to: Dr. Ara A. Salibian, Division of Plastic & Reconstructive Surgery, University of California, Davis School of
Medicine, 2335 Stockton Blvd., NAOB, 6th Floor, Sacramento, CA 95817, USA. E-mail: asalibian@ucdavis.edu

How to cite this article: Farajzadeh MM, Salibian AA. Optimizing perfusion and volume in autologous breast reconstruction:
dual-plane, conjoined and stacked flaps. Plast Aesthet Res 2024;11:32. https://dx.doi.org/10.20517/2347-9264.2024.24

Received: 16 Feb 2024 First Decision: 8 Jul 2024 Revised: 16 Jul 2024 Accepted: 26 Jul 2024 Available Online: 31 Jul 2024
Academic Editors: Roberto Cuomo, Marten Basta Copy Editor: Yanbin Bai Production Editor: Yanbin Bai

Abstract
Microsurgical breast reconstruction has continued to evolve to improve outcomes and minimize complications.
Dual-plane, conjoined and stacked flaps represent one aspect of this evolution in an effort to improve tissue
perfusion and flap volume. Dual-plane flaps combine the superficial and deep circulation in abdominally-based free
flaps to augment perfusion. Conjoined flaps use additional pedicles to supply multiple perforasomes combined in a
single flap. Stacked flaps utilize separate flaps on individual pedicles to increase volume at a single recipient site.
Multiple donor sites, pedicle configurations and recipient vessel choices have been described, primarily focusing on
using the cranial and caudal internal mammary system as well as intra-flap anastomoses. Though more technically
demanding, dual-plane, stacked and conjoined flaps allow for improvement in flap perfusion and volume, and are
important tools for optimizing results in autologous breast reconstruction.

Keywords: Autologous, breast, microsurgery, stacked flap, conjoined flap, dual plane flap, DIEP

INTRODUCTION
Since the description of the free transverse rectus abdominis myocutaneous (TRAM) flap in 1979,
microvascular breast reconstruction has continuously evolved to refine outcomes and minimize
[1]
morbidity . Autologous breast reconstruction has demonstrated consistently high rates of patient

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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