Choice of flaps for breast reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery

Background:

• Autogenous breast reconstruction provides a safe, reliable alternative to implants, creating natural-looking breast mounds with minimal donor-site morbidity.
• The transverse rectus abdominis musculocutaneous (TRAM) flap is a popular autogenous method, with ongoing refinements to optimize blood supply and minimize abdominal wall defects.

Purpose of the Study:

• To review modern trends and modifications in autogenous breast reconstruction techniques.
• To highlight the advantages and increasing use of the deep inferior epigastric perforator (DIEP) flap.

Main Methods:

• Review of current literature on TRAM flap modifications and alternative autogenous flaps.
• Comparison of different flap techniques regarding outcomes, blood supply, and donor-site morbidity.

Main Results:

• The pedicled TRAM flap, while common, has required modifications like bipedicled, free, and supercharged TRAM flaps due to indirect blood supply.
• Muscle-sparing free TRAM, DIEP, and SIEA flaps were developed to reduce donor-site morbidity.
• The DIEP flap demonstrates proven reliability and low complication rates, with increasing surgical adoption.

Conclusions:

• The DIEP flap is a reliable and increasingly utilized technique for autogenous breast reconstruction, offering excellent outcomes with reduced donor-site issues.
• Alternative flaps like the latissimus dorsi and gluteus maximus are considered when free TRAM modifications are not feasible.