Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Multiple perforator flap breast reconstruction avoids implants for selected patients with limited donor tissue.
• This technique provides additional skin for a natural breast envelope and volume for a body-appropriate mound, avoiding serial fat grafting.
• Bilateral stacked flap reconstruction, using four flaps for two breasts, is now feasible due to advancements in microsurgical techniques and co-surgery.

Purpose of the Study:

• To describe the early experience with bilateral stacked flap breast reconstruction.
• To evaluate the feasibility and outcomes of using stacked perforator flaps for immediate or delayed breast reconstruction.

Main Methods:

• Fifty consecutive bilateral stacked flap operations were performed between January 2014 and October 2018.
• Reconstructions were delayed, with a mean operative time of 10 hours.
• Deep inferior epigastric perforator and profunda artery perforator flaps were most commonly used, with microanastomoses to internal mammary vessels.

Main Results:

• A low flap loss rate of 2.5% (5 out of 200 flaps) was observed.
• Seven take-backs were required for flap-related issues, including two negative explorations and one flap salvage.
• The most frequent non-flap complication was thigh wounds, with 17 total cases requiring procedures in eight patients.

Conclusions:

• Bilateral stacked flap breast reconstruction is a powerful technique for selected patients.
• The procedure can be performed with acceptable microsurgical risk.
• An acceptable complication profile was noted in this early experience.