ABSTRACT
Breast reconstruction in patients who have already undergone traditional radical mastectomy
can be very challenging for plastic surgeons. These patients require not only correction
of breast deformities but also correction of subclavian and anterior axillary fold
deformities. Usually the entire transverse rectus abdominal myocutaneous (TRAM) or
deep inferior epigastric perforator (DIEP) flap (including zone IV) must be used.
To achieve this, bipedicled deep inferior epigastric vessels (DIEV) are needed to
ensure that the entire flap will survive completely. On the chest, however, it is
difficult to find two sets of suitable recipient vessels for the two pedicles. The
thoracodorsal vessels have often been damaged during axillary dissection or radiation
therapy. In the past, surgeons have used the proximal end of the internal mammary
artery and vein (IMA, IMV) as the recipient vessels in breast reconstruction with
free flaps, with ligation of the distal ends. Here, we use both the proximal and distal
ends of IMA and IMV as recipient vessels for end-end anastomoses to the bipedicled
deep inferior epigastric artery and deep inferior epigastric vein vessels in seven
TRAM cases and five DIEP cases. Very satisfactory results are obtained. Our clinical
and experimental studies indicate that the distal IMA has reduced perfusion pressure
but still can provide excellent flow and flap perfusion. This technique allows reliable
use of two pedicles for survival of the entire flap.
KEYWORD
Bipedicled deep inferior epigastric perforator flap - free transverse rectus abdominal
myocutaneous flap - proximal and distal ends of internal mammary artery - breast reconstruction
