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Tang et al. Plast Aesthet Res 2024;11:61 https://dx.doi.org/10.20517/2347-9264.2024.117 Page 5 of 15

Figure 2. Volume Rendering of breasts and abdominal flaps (blue corresponds to the breast/flap for reconstruction and yellow the
breast/flap for the augmentation) with superimposed perforators and the recommended location for flap division.

Conventionally, we prefer to use the contralateral abdominal flap for the reconstructive breast. It is also
feasible to use the ipsilateral abdomen if the perforators on the ipsilateral side are easier to harvest and have
an anatomic configuration that better minimizes injury to the rectus abdominus muscle. The flaps used for
augmentation in these patients are typically smaller and can be supplied by lateral row perforators.
Typically, only a single perforator may be needed given the smaller size of the flap and this will also
optimize the length of the pedicle in order to be passed through a subcutaneous tissue over the sternum and
allow for a tension-free anastomosis to the recipient vessels. Often, a high lateral perforator can be used to
supply the augmentation DIEP and the resultant pedicle length can be around 15 cm. If lateral row
perforators are not present, consideration can be given to harvest of a superficial inferior epigastric artery
(SIEA) flap or superficial circumflex iliac artery perforator (SCIP) flap ; the utility of these flaps would be
[6]
dependent on pedicle length given the need to cross over to the contralateral chest recipient vessels.