Subscribe to RSS

DOI: 10.1055/a-2086-5667
DIEP Flap Transplantation in Monozygotic Twins for Breast Reconstruction: A Case Report and Literature Review
Funding None.

Abstract
Background Composite tissue allotransplants are performed for various defects when local, or distant reconstructive options are limited. Though this type of transplant replaces similar tissue, it is complicated by immunosuppression. This limitation may be avoided in monozygotic twins since they share identical genetic code. Free soft tissue transplantation across identical twins has been reported for breast, scalp, and thoracic reconstruction when autologous tissues were insufficient. We present a case of a successful deep inferior epigastric artery perforator (DIEP) flap transplantation in monozygotic twins.
Methods The recipient twin was a patient with history of breast cancer and failed prosthetic reconstruction. She desired autologous reconstruction with a DIEP flap but had insufficient donor tissue. She refused alternative sites; however, she had an identical twin willing to donate her excess abdominal tissue. The twins underwent deoxyribonucleic acid testing, human leukocyte antigen/blood type testing, and screening for communicable diseases.
Results The twins were found to have greater than 99.99% probability of being monozygotic twins. A bipedicled conjoined DIEP was harvested from donor twin and transplanted to recipient twin. Immunosuppressive regimen was not utilized. Patients healed uneventfully and are currently 5 years postop without long-term complications.
Conclusion Isogeneic flap transplant is a viable option to consider when autologous tissues are restricted, and monozygotic twins are present. Appropriate counseling of twins is critical for a successful and satisfactory outcome.
Keywords
twin transplantation - soft tissue transplantation - breast reconstruction - flap transplantation - DIEP transplantationEthical Approval
IRB approval (#281415) was obtained for retrospective review of the patient's charts.
Presented at: Plastic Surgery the Meeting (ASPS) 2020 (virtual)
Publication History
Received: 07 December 2022
Accepted: 28 February 2023
Accepted Manuscript online:
04 May 2023
Article published online:
23 June 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Kessaris N, Mukherjee D, Chandak P, Mamode N. Renal transplantation in identical twins in United States and United Kingdom. Transplantation 2008; 86 (11) 1572-1577
- 2 Allen Jr RJ, LoTempio MM, Craigie JE, Allen Sr RJ. Transplantation in identical twins: another option for breast reconstruction. Plast Reconstr Surg 2008; 122 (04) 1019-1023
- 3 Hazani R, Coots BK, Buntic RF, Brooks D. Bilateral breast reconstruction: the simultaneous use of autogenous tissue and identical twin isograft. Ann Plast Surg 2009; 63 (05) 496-498
- 4 Buncke HJ, Hoffman WY, Alpert BS, Gordon L, Stefani AE. Microvascular transplant of two free scalp flaps between identical twins. Plast Reconstr Surg 1982; 70 (05) 605-609
- 5 Valauri FA, Buncke HJ, Alpert BS, Lineaweaver WC, Argenta LC. Microvascular transplantation of expanded free scalp flaps between identical twins. Plast Reconstr Surg 1990; 85 (03) 432-436
- 6 Banwell ME, Clibbon JJ, Sassoon EM. Transplantation of a latissimus dorsi flap between identical twins. J Plast Reconstr Aesthet Surg 2011; 64 (10) 1366-1369
- 7 Selber JC, Kameni L, Torres K. et al. Successful double DIEP syngeneic transplantation across monozygotic twins for total back reconstruction. Plast Reconstr Surg 2021; 148 (05) 1125-1133
- 8 Park JS, Park JJ, Kim DY, Eom JS. Emergency transplantation of free flap between separated thoraco-omphalopagus conjoined twins. Arch Plast Surg 2016; 43 (01) 97-99
- 9 Maguire GP, Lee EG, Bevington DJ, Küchemann CS, Crabtree RJ, Cornell CE. Psychiatric problems in the first year after mastectomy. BMJ 1978; 1 (6118): 963-965
- 10 Penman DT, Bloom JR, Fotopoulos S. et al. The impact of mastectomy on self-concept and social function: a combined cross-sectional and longitudinal study with comparison groups. Women Health 1986; 11 (3-4): 101-130
- 11 Pien I, Caccavale S, Cheung MC. et al. Evolving trends in autologous breast reconstruction: is the deep inferior epigastric artery perforator flap taking over?. Ann Plast Surg 2016; 76 (05) 489-493
- 12 Kamali P, Paul MA, Ibrahim AMS. et al. National and regional differences in 32,248 postmastectomy autologous breast reconstruction using the Updated National Inpatient Survey. Ann Plast Surg 2017; 78 (06) 717-722
- 13 Fischer SA, Avery RK. AST Infectious Disease Community of Practice. Screening of donor and recipient prior to solid organ transplantation. Am J Transplant 2009; 9 (Suppl. 04) S7-S18
- 14 Benedetti E, Dunn T, Massad MG. et al. Successful living related simultaneous pancreas-kidney transplant between identical twins. Transplantation 1999; 67 (06) 915-918
- 15 Liu LU, Schiano TD, Min AD. et al. Syngeneic living-donor liver transplantation without the use of immunosuppression. Gastroenterology 2002; 123 (04) 1341-1345
- 16 Yoshizawa A, Takada Y, Fujimoto Y. et al. Liver transplantation from an identical twin without immunosuppression, with early recurrence of hepatitis C. Am J Transplant 2006; 6 (11) 2812-2816
- 17 Blitzer D, Yedlicka G, Manghelli J, Dentel J, Caldwell R, Brown JW. Twin-to-twin heart transplantation: a unique event with a 25-year follow-up. Ann Thorac Surg 2017; 103 (04) e341-e342
- 18 Barwick WJ, Oakes J, Goldberg JA. Closure of myelomeningocele using skin from stillborn twin. Ann Plast Surg 1993; 30 (02) 171-174
- 19 Turk E, Karagulle E, Turan H. et al. Successful skin homografting from an identical twin in a severely burned patient. J Burn Care Res 2014; 35 (03) e177-e179
- 20 Segerberg EC, Grubb WG, Henderson AE. The first successful parathyroid transplant from an identical twin for the cure of permanent postoperative hypoparathyroidism. Surgery 1992; 111 (03) 357-358
- 21 Silber SJ. Transplantation of a human testis for anorchia. Fertil Steril 1978; 30 (02) 181-187
- 22 Fattah A, Cypel T, Donner EJ, Wang F, Alman BA, Zuker RM. The first successful lower extremity transplantation: 6-year follow-up and implications for cortical plasticity. Am J Transplant 2011; 11 (12) 2762-2767
- 23 Thaunat O, Badet L, Dubois V, Kanitakis J, Petruzzo P, Morelon E. Immunopathology of rejection: do the rules of solid organ apply to vascularized composite allotransplantation?. Curr Opin Organ Transplant 2015; 20 (06) 596-601
- 24 Machin G. Non-identical monozygotic twins, intermediate twin types, zygosity testing, and the non-random nature of monozygotic twinning: a review. Am J Med Genet C Semin Med Genet 2009; 151C (02) 110-127
- 25 Silva S, Martins Y, Matias A, Blickstein I. Why are monozygotic twins different?. J Perinat Med 2011; 39 (02) 195-202
- 26 Day E, Kearns PK, Taylor CJ, Bradley JA. Transplantation between monozygotic twins: how identical are they?. Transplantation 2014; 98 (05) 485-489
- 27 Krishnan N, Buchanan PM, Dzebisashvili N, Xiao H, Schnitzler MA, Brennan DC. Monozygotic transplantation: concerns and opportunities. Am J Transplant 2008; 8 (11) 2343-2351
- 28 Hüser N, Matevossian E, Schmidbauer P. et al. Calculated withdrawal of low-dose immunosuppression based on a detailed immunological monitoring after kidney transplantation between monocygotic twins. Transpl Immunol 2009; 22 (1–2): 38-43
- 29 Kim YK, Yoon HE, Kim SH. et al. Long-term follow-up of three identical twin transplant recipients without maintenance immunosuppressive therapy. Nephrology (Carlton) 2008; 13 (05) 447-448
- 30 Rao Z, Huang Z, Song T, Lin T. A lesson from kidney transplantation among identical twins: case report and literature review. Transpl Immunol 2015; 33 (01) 27-29
- 31 Mucci LA, Hjelmborg JB, Harris JR. et al; Nordic Twin Study of Cancer (NorTwinCan) Collaboration. Familial risk and heritability of cancer among twins in Nordic countries. JAMA 2016; 315 (01) 68-76
- 32 Gonçalves DU, Proietti FA, Ribas JG. et al. Epidemiology, treatment, and prevention of human T-cell leukemia virus type 1-associated diseases. Clin Microbiol Rev 2010; 23 (03) 577-589
- 33 Woolley AE, Singh SK, Goldberg HJ. et al; DONATE HCV Trial Team. Heart and lung transplants from HCV-infected donors to uninfected recipients. N Engl J Med 2019; 380 (17) 1606-1617
- 34 Veroux M, Ardita V, Corona D. et al. Kidney transplantation from donors with hepatitis B infection. Med Sci Monit 2016; 22 (22) 1427-1434
- 35 Cortes NJ, Afzali B, MacLean D. et al. Transmission of syphilis by solid organ transplantation. Am J Transplant 2006; 6 (10) 2497-2499
- 36 Boeckh M, Ljungman P. How we treat cytomegalovirus in hematopoietic cell transplant recipients. Blood 2009; 113 (23) 5711-5719
- 37 Ramanan P, Razonable RR. Cytomegalovirus infections in solid organ transplantation: a review. Infect Chemother 2013; 45 (03) 260-271