The Lumbar Artery Perforator Free Flap as an Alternative Option for Breast Reconstruction in Low BMI Patients: Analysis of CT Angiography of Donor Sites Across BMI

Abstract

Background In patients with a low body mass index (BMI), the options for autologous breast reconstruction are limited. With the hypothesis that adipose tissue deposition favors the lumbar region over the abdominal wall, this study sought to investigate the lumbar artery perforator (LAP) flap as an alternative reconstructive option in patients with deficient autologous donor sites consequent to a low BMI.

Methods A retrospective cohort analysis was performed, from a prospectively maintained database, of all consecutive deep inferior epigastric artery perforator flap breast reconstructions performed in our unit. A randomized selection of 100 patients with low BMI < 22, normal BMI 22 to 24, and high BMI > 30 was performed. Patient computerized tomography scans were analyzed to measure abdominal wall and lumbar tissue thickness and to define anatomical landmark relations of the LAP.

Results A statistically significant difference was identified between the ratio of lumbar-to-abdominal wall thickness between BMI groups, highlighting preservation of the lumbar thickness in patients with low BMI. The mean distance at which the fourth lumbar perforator entered the subcutaneous tissues was 7.7 cm lateral to the spinous process (range 6.4–9.5 cm), with no significant difference between BMI groups, highlighting this consistent anatomical position.

Conclusion This study confirms a greater lumbar-to-abdominal wall thickness, therefore volume, in low BMI patients, with consistent lumbar perforator anatomy of 6.4 to 9.5 cm lateral to the spinous process. The LAP flap should therefore be strongly considered for autologous breast reconstruction in this patient cohort.

Keywords

lumbar artery perforator free flap - low BMI - autologous reconstruction

Ethical Considerations

The principles outlined in the Declaration of Helsinki have been followed.

Funding

None.

Publikationsverlauf

Eingereicht: 12. April 2024

Angenommen: 28. August 2024

Accepted Manuscript online:
03. Oktober 2024

Artikel online veröffentlicht:
21. November 2024

• References

• 1 de Weerd L, Elvenes OP, Strandenes E, Weum S. Autologous breast reconstruction with a free lumbar artery perforator flap. Br J Plast Surg 2003; 56 (02) 180-183
• 2 Healthy Weight, Nutrition and Physical Activity (2024) CDC publication. Accessed 08 March 2024 at: https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html
• 3 Haddock NT, Martinez VM, Teotia SS. Surgical outcomes of autologous breast reconstruction in low body mass index patients: beyond the standard DIEP flap. Plast Reconstr Surg 2023; 152 (4S): 3S-15S
• 4 Opsomer D, Stillaert F, Blondeel P, Van Landuyt K. The lumbar artery perforator flap in autologous breast reconstruction: initial experience with 100 cases. Plast Reconstr Surg 2018; 142 (01) 1e-8e
• 5 Peters KT, Blondeel PN, Lobo F, van Landuyt K. Early experience with the free lumbar artery perforator flap for breast reconstruction. J Plast Reconstr Aesthet Surg 2015; 68 (08) 1112-1119
• 6 Hurley AR, Zoccali G, Tasoulis MK. et al. Preoperative volume estimation in transverse upper gracilis flap surgery: a pilot study. J Plast Reconstr Aesthet Surg 2021; 74 (11) 2891-2898
• 7 Nanidis TG, Ridha H, Jallali N. The use of computed tomography for the estimation of DIEP flap weights in breast reconstruction: a simple mathematical formula. J Plast Reconstr Aesthet Surg 2014; 67 (10) 1352-1356
• 8 Kato H, Hasegawa M, Takada T, Torii S. The lumbar artery perforator based island flap: anatomical study and case reports. Br J Plast Surg 1999; 52 (07) 541-546
• 9 Offman SL, Geddes CR, Tang M, Morris SF. The vascular basis of perforator flaps based on the source arteries of the lateral lumbar region. Plast Reconstr Surg 2005; 115 (06) 1651-1659
• 10 Sultan SM, Greenspun DT. Lumbar artery perforator flaps in autologous breast reconstruction. Clin Plast Surg 2023; 50 (02) 301-312
• 11 Hamdi M, Craggs B, Brussaard C, Seidenstueker K, Hendrickx B, Zeltzer A. Lumbar artery perforator flap: an anatomical study using multidetector computed tomographic scan and surgical pearls for breast reconstruction. Plast Reconstr Surg 2016; 138 (02) 343-352
• 12 Stillaert FBJL, Opsomer D, Blondeel PN, Van Landuyt K. The lumbar artery perforator flap in breast reconstruction. Plast Reconstr Surg 2023; 151 (01) 41-44
• 13 Haddock NT, Teotia SS. Lumbar artery perforator flap: initial experience with simultaneous bilateral flaps for breast reconstruction. Plast Reconstr Surg Glob Open 2020; 8 (05) e2800
• 14 Opsomer D, Vyncke T, Ryx M, Van Landuyt K, Blondeel P, Stillaert F. Donor site morbidity after lumbar artery perforator flap breast reconstruction. J Reconstr Microsurg 2022; 38 (02) 129-136