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Original Article Plastic and Aesthetic Research

Simultaneous expander and deep inferior

epigastric perforator reconstruction:

indications and alloderm sling technique for

protecting the anastomosis

Elizabeth Stirling Craig, Ajul Shah, Sarah Persing, Jeffrey Salomon, Stefano Fusi
Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.

Address for correspondence: Dr. Ajul Shah, Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of
Medicine, New Haven, CT 06520, USA. E-mail: ajul.shah@yale.edu

ABSTRACT
Aim: Autologous tissue is considered the “gold standard” for breast reconstruction today. However,
little is known about deep inferior epigastric perforator (DIEP) flap reconstruction in combination with
tissue expander (TE)/implant. The authors describe a series of combined DIEP flap/TE reconstruction,
including its indications and technique to ensure protection of the pedicle during the expansion
process. Methods: Between January 2009 and December 2012, patients undergoing immediate DIEP
with TE reconstruction were retrospectively reviewed. Oncologic, comorbid conditions, intraoperative,
postoperative expansion, complications, and technique data points were collected. Photographs were
taken postoperatively and patient’s satisfaction surveys were obtained to assess overall satisfaction.
Results: Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm
sling technique. There were no complications to the pedicle, flap, expander, or mastectomy skin
perioperatively or postoperatively. All patients describe being very satisfied, often with improved
breast volume and projection as compared to their preoperative appearance. Conclusion: The results
of this study suggest that DIEP flap/TE reconstruction is safe, in particular when utilizing the alloderm
sling technique, and should be considered in patients who lack sufficient abdominal tissue, have
existing breast asymmetries, or do not desire the scar deformity of latissimus dorsi.

Key words:
Alloderm, autologous, breast cancer, breast reconstruction, deep inferior epigastric perforator, tissue
expander

INTRODUCTION recently the deep inferior epigastric perforator (DIEP)
flap, is now considered the “gold standard” for breast
The overall goal of breast reconstruction is to recreate the reconstruction due to its ability to recreate natural and
most naturally appearing and feeling breasts for patients aesthetic results. However, not all women have sufficient
with breast cancer who are treated with mastectomies. abdominal tissue to make an aesthetically appearing
Autologous reconstruction with either the transverse breast. Often, in these cases, an alternative technique
rectus abdominus myocutaneous (TRAM) flap, or more for breast reconstruction is the latissimus dorsi (LD) flap
[1]
with an expander/implant. Miller et al. demonstrated
Access this article online that TRAM flap reconstruction can be simultaneously
Quick Response Code: performed with placement of a tissue expander (TE) to
Website: provide improved volume and projection in safe manner
www.parjournal.net
for patients who have a thin body habitus with medium
to large‑sized breasts. Donor site and aesthetic outcomes
DOI: proved to be statistically improved in patients who
10.4103/2347-9264.153201 underwent TRAM/implant reconstruction when compared
to LD/implant reconstruction. Figus et al. applied these
[3]
[2]
Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015 63