Alternative flaps in autologous breast reconstruction.

Area of Science:

• Microsurgery
• Plastic Surgery
• Oncologic Reconstruction

Background:

• Deep inferior epigastric artery perforator flap is the gold standard for autologous breast reconstruction.
• Not all patients are candidates for abdominally based free tissue transfer.
• Alternative donor sites are crucial for expanding reconstructive options.

Purpose of the Study:

• To review alternative autologous flap options for breast reconstruction.
• To discuss the history, anatomy, surgical techniques, and outcomes of these flaps.
• To explore advanced techniques like preoperative imaging and flap stacking.

Main Methods:

• Literature review of alternative flap options for autologous breast reconstruction.
• Discussion of thigh-based flaps (gracilis, profunda artery perforator, lateral thigh) and trunk-based flaps (lumbar, gluteal).
• Inclusion of preoperative imaging (CTA, MRA) and novel applications (neurotization, stacking).

Main Results:

• Several alternative flaps from the thigh and trunk exist for patients unsuitable for DIEP flap.
• These flaps offer viable options with varying anatomical considerations and surgical approaches.
• Preoperative imaging and innovative techniques can enhance reconstructive outcomes.

Conclusions:

• Alternative flaps provide essential options for autologous breast reconstruction when the DIEP flap is not possible.
• Understanding the anatomy and techniques of these diverse flaps is vital for surgeons.
• Advancements in imaging and surgical techniques expand the possibilities in breast reconstructive microsurgery.