Split bipedicle transverse rectus abdominis flaps: expanding their uses in breast reconstruction

A total of 34 breasts were reconstructed in 21 women, with the bipedicle transverse rectus abdominis island flap technique. Thirteen women had bilateral breast reconstructions and 8 had unilateral reconstructions. The indications for using this technique are (1) bilateral breast defects, (2) a radical mastectomy defect, (3) limited donor tissue or tissue compromised by prior abdominal surgery, and (4) a large, remaining breast that requires matching. Four selected women are presented to illustrate each indication. In all but 1 woman, the abdominal islands were bisected and transferred to the chest defects with their respective rectus muscles and vascular pedicles. Complications included 2 women with abdominal wall hernia, 3 women with minimal peripheral skin necrosis of the reconstructed breasts, and 1 woman with Raynaud's disease with partial flap loss. Follow-up ranged from 3 to 57 months. Bipedicle rectus abdominis flaps provide improved vascularity and allow greater flexibility in bilateral and unilateral breast reconstruction.