Advances in deep inferior epigastric perforator flap breast reconstruction

Abstract

: Over the last three decades, the deep inferior epigastric perforator (DIEP) flap has emerged as the primary and preferred method for autologous breast reconstruction for women with breast cancer. DIEP flaps allow for autologous tissue reconstruction without significant sacrifice of abdominal wall musculature. Several advancements and refinements have been made in terms of performing DIEP flap surgery since its initial description in all aspects of the flap planning process. Pre-operatively, computed tomography angiography imaging can be obtained to aid in perforator mapping for flap planning and dissection. Intra-operatively, indocyanine green angiography can be performed to evaluate flap perfusion and allow for on the table adjustments of flap design. The use of these imaging modalities can contribute to reduced perforator dissection times with increase in operative speed and improvements in flap survival. In addition, DIEP flaps enhancements with flap neurotization or concurrent transfer of adjacent lymph nodes may allow for improved post-operative outcomes with enhanced sensory recovery and improvement in secondary lymphedema. Here, we review these recent advancements in deep inferior epigastric perforator flap breast reconstruction.