Inset of Unilateral Dual Microvascular Breast Reconstruction Using Nonabdominal Free Tissue Transfer.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Autologous breast reconstruction presents challenges for large-breasted patients with inadequate abdominal tissue.
• Double unilateral free flaps, specifically transverse upper gracilis (TUG) and profunda artery perforator (PAP) flaps, are explored for these cases.

Purpose of the Study:

• To review the authors' experience with TUG and PAP flaps for unilateral breast reconstruction.
• To evaluate the safety and reliability of different vascular anastomotic orientations for double free tissue transfer.

Main Methods:

• Retrospective chart review of 21 subjects undergoing 42 free tissue transfers for unilateral breast reconstruction.
• Subjects categorized into three groups based on vascular anastomotic orientation: thoracodorsal/internal mammary, noncrossed internal mammary, and crossed internal mammary.

Main Results:

• Group 3 (crossed internal mammary) demonstrated significantly lower perioperative complication rates (5.5%) and higher flap survival (100%) compared to Group 1 (50% complications, 75% survival) and Group 2 (100% complications, 0% survival).
• Statistical analysis confirmed significant differences in both perioperative complications (p = 0.0011) and flap survival (p = 0.0008) across the groups.

Conclusions:

• Double free tissue transfer using TUG or PAP flaps is a viable option for unilateral autologous breast reconstruction.
• Horizontal inset with crossed pedicles to the internal mammary system is identified as the safest and most reliable technique for flap inset in this patient population.