BACKGROUND: The deep inferior epigastric perforator (DIEP) flap has become the gold standard for autologous tissue breast reconstruction. When present, large-caliber septocutaneous (sc) perforators may be identified by preoperative imaging. We describe a new technique for perforator flap breast reconstruction based on the sc perforators of the deep inferior epigastric artery. Advantages of the sc-DIEP flap include larger vessels, quicker and easier flap elevation, and less potential donor site morbidity.
METHODS: A retrospective review was done of 90 consecutive DIEP flaps performed from January 2008-January 2009. Preoperative imaging with CT or MR angiography allowed visualization of the microvascular anatomy. When present, sc perforators were mapped on an x-y axis with the umbilicus as reference. Perforator size was graded as small, medium or large. Based on preoperative imaging, a detailed operative plan was created prior to marking the patient.
RESULTS: Seventeen sc-DIEP breast reconstructions were reported. Six sc-DIEPs were located at or superior to the umbilicus. Six sc-DIEPs were classified as large. All flaps (n=17) were based on one sc perforator. One patient had clinically significant fat necrosis. There were no flap losses.
CONCLUSIONS: The sc-DIEP flap represents a significant advance in perforator flap breast reconstruction. The sc-DIEP is based on a single large terminal vessel that eliminates the intramuscular dissection of the standard DIEP. Advantages of the sc-DIEP flap include a larger perforator, more efficient flap elevation, and less potential donor site morbidity. Thus, the sc-DIEP is a reliable technique that has become our first choice for autologous tissue breast reconstruction.