The efficacy of bilateral lower abdominal free flaps for unilateral breast reconstruction

BACKGROUND: In large-breasted women, those with midline abdominal scars, or those with scant abdominal tissue, a unipedicled lower abdominal flap may be insufficient for breast reconstruction. In these circumstances, bipedicled flaps may best satisfy the reconstructive requirements, but outcomes with bilateral free flaps for unilateral breast reconstruction are generally lacking. METHODS: A retrospective review of patients in whom two vascular pedicles/flaps were used to simultaneously reconstruct a single breast was used to assess operative outcomes. RESULTS: Forty patients (80 flaps) for whom two free tissue transfers were used to simultaneously reconstruct a single breast were identified. The majority of patients had a native breast cup size of C or larger. The flaps used included the superficial inferior epigastric artery (SIEA) flap (n = 29; 36 percent), the transverse rectus abdominis musculocutaneous (TRAM) flap (n = 9; 11 percent), the muscle-sparing TRAM flap (n = 15; 19 percent), and the deep inferior epigastric perforator (DIEP) flap (n = 27; 34 percent). Flaps were paired in a variety of configurations, most commonly using a muscle-sparing TRAM flap in conjunction with a DIEP flap or an SIEA flap. Recipient vessels included a combination of the internal mammary and thoracodorsal vessels and the pedicles of combined flaps (turbocharged). There were no flap losses. Two flaps required reexploration for microsurgical anastomotic revision, and both were successfully salvaged. Isolated fat necrosis was encountered in only three of 80 flaps. CONCLUSIONS: This study suggests that bilateral, bipedicled, abdominal free flaps for unilateral breast reconstruction can be used safely with a high degree of success. These combined flaps provide for enhanced vascular perfusion of the lower abdominal flap territory, allowing for harvest of larger volumes of tissue for reconstruction.