Breast Reconstruction Using the Vertical Multiperforator Deep Inferior Epigastric Perforator Flap: Report of Two...

In breast reconstruction with autologous tissue for thin patients or those with extensive skin defects, conventional horizontal abdominal flaps may not provide sufficient tissue volume. Here, we report that by using the vertical multiperforator (m-p) deep inferior epigastric perforator (DIEP) flap, we were able to obtain sufficient tissue volume using a single vascular pedicle and achieve successful reconstruction in two patients for whom symmetrical breast reconstruction with the conventional transverse DIEP flap was challenging. In both cases, the flaps marked on the abdomen beforehand were larger in the vertical orientation than in the horizontal orientation. We also analyzed the flap hemodynamics in both cases. The first case was that of a 52-year-old woman with breast cancer in the right C region. Owing to insufficient flap volume with the conventional DIEP flap, primary one-stage reconstruction was performed using the vertical m-p DIEP flap. The second case was that of a 52-year-old woman who had undergone partial mastectomy for left A-region breast cancer at another institution and subsequently experienced four local recurrences, each treated with additional partial resection. Total mastectomy was planned for the fifth local recurrence. As the breast skin excision extended beyond the midline to the contralateral side, a vertical m-p DIEP flap with a larger skin paddle was used for primary one-stage reconstruction. No complications involving either the flap or the abdomen have been observed: Case 1 at 3 years postoperatively and Case 2 at 1 year and 7 months postoperatively. These findings indicate that the vertical m-p DIEP flap may be useful when symmetrical breast reconstruction with a conventional transverse DIEP flap is challenging.