Page 86 - Read Online

Tuinder et al. Plast Aesthet Res 2024;11:38 Plastic and
DOI: 10.20517/2347-9264.2024.40
Aesthetic Research

Technical Note Open Access

Microvascular autologous breast reconstruction
with the lateral thigh perforator flap

1
Stefania M. H. Tuinder 1 , Joep A. F. Van Rooij , Robert J. Allen 2
1
Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht 6229 HX, The
Netherlands.
2
Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
Correspondence to: Dr. Stefania M. H. Tuinder, Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University
Medical Centre, P. O. Box 5800, 6202 AZ, Maastricht, The Netherlands. E-mail: s.tuinder@mumc.nl

How to cite this article: Tuinder SMH, Van Rooij JAF, Allen RJ. Microvascular autologous breast reconstruction with the lateral
thigh perforator flap. Plast Aesthet Res 2024;11:38. https://dx.doi.org/10.20517/2347-9264.2024.40

Received: 20 Mar 2024 First Decision: 8 Jul 2024 Revised: 17 Jul 2024 Accepted: 13 Aug 2024 Published: 21 Aug 2024
Academic Editor: Pietro Gentile Copy Editor: Yu-Fei Wang Production Editor: Yu-Fei Wang

Abstract
The lateral thigh perforator flap is an excellent alternative to the deep inferior epigastric artery perforator (DIEP)
flap for patients with absolute or relative contraindications for a DIEP flap and adequate volume at the lateral thigh.
Preoperative physical examination, preoperative markings, and radiological perforator mapping are essential for
adequate surgical preparation. The flap is based on septocutaneous perforators of the lateral circumflex femoral
artery, located in the posterior septum between the tensor fascia latae and the gluteus medius muscle. Being
relatively stiff, septocutaneous perforators are sensitive to kinking and compression, which is important to keep in
mind during flap inset. A donor nerve can be taken and coapted with the flap for sensate autologous breast
reconstruction. For larger breast volumes, bipedicled, conjoined, or stacked flaps are viable options. Quilting
sutures during donor site closure is crucial in risk reduction of seroma formation and wound dehiscence.
Complication risks seem comparable to other free flap breast reconstructions, such as the DIEP flap, especially
when applying the quilting sutures at the donor site. During postoperative control visits at the outpatient clinic,
additional procedures will be discussed, which often consist of lipofilling in the pectoralis major muscle for
increasing upper pole volume, liposuction of the non-operated lateral thigh for symmetry in unilateral cases, or
dog-ear corrections at the donor site.

Keywords: Breast reconstruction, autologous breast reconstruction, lateral thigh perforator flap, microsurgery, free
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
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.oaepublish.com/par