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Garoosi et al. Plast Aesthet Res 2024;11:42 Plastic and
DOI: 10.20517/2347-9264.2024.57
Aesthetic Research

Review Open Access

Modern approaches to alternative flap-based breast
reconstruction: stacked deep inferior epigastric

perforator flaps

2
1
2
Kassra Garoosi 1 , Kate Kelson , Julian Winocour , David Mathes , Christodoulos Kaoutzanis 2
1
School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80405, USA.
2
Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80405, USA.
Correspondence to: Dr. Christodoulos Kaoutzanis, Division of Plastic and Reconstructive Surgery, University of Colorado
Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80405, USA. E-mail: ckaoutzanis@gmail.com
How to cite this article: Garoosi K, Kelson K, Winocour J, Mathes D, Kaoutzanis C. Modern approaches to alternative flap-based
breast reconstruction: stacked deep inferior epigastric perforator flaps. Plast Aesthet Res 2024;11:42. https://dx.doi.org/10.
20517/2347-9264.2024.57
Received: 15 Apr 2024 First Decision: 26 Jul 2024 Revised: 9 Aug 2024 Accepted: 16 Aug 2024 Published: 24 Aug 2024

Academic Editor: Raymund E. Horch Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
Autologous breast reconstruction has greatly evolved with the introduction of stacked deep inferior epigastric
perforator (DIEP) flaps, providing a sophisticated option for patients with insufficient donor tissue or those
requiring substantial breast mounds. This technique utilizes either conjoined/bipedicled or separate abdominal
flaps to recreate the breast with natural-looking results and high satisfaction rates. Preoperative planning is critical,
involving detailed vascular mapping to ensure successful outcomes. Despite the complexity of the procedure, the
complication profile remains comparable to non-stacked methods, with a notable reduction in fat necrosis and no
significant increase in overall risk. Similar to the DIEP flap, possible complications related to the stacked DIEP flap
include donor-site morbidity such as abdominal bulge or hernia, and complications at the recipient site such as flap
ischemia or fat necrosis. The stacked DIEP flap technique has improved the symmetry and volume matching of
reconstructed breasts while maintaining abdominal integrity, marking a significant advancement in the field that
aligns with the aesthetic aspirations of patients undergoing mastectomy.

Keywords: Autologous breast reconstruction, DIEP flap, stacked flap, conjoined flap, bipedicled flap

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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