Prevalence and Utilization of Obturator Artery Anatomic Variant in Stacked DIEP Flap Breast Reconstruction

Abstract

OBJECTIVES: The objective of this study is to quantify the prevalence of a vascular anatomic variant in which the obturator artery (OA) branches off of the proximal deep inferior epigastric artery (DIEA) in autologous breast reconstruction candidates. Preserving this branch in stacked flap or dual-pedicle reconstructions allows for flow-through anastomosis and gives antegrade flow to both flaps. MATERIALS AND METHODS: Pre-operatively obtained abdomen/pelvis CTA images of 120 breast reconstruction patients were retrospectively assessed for the presence of the OA arising from the proximal DIEA. RESULTS: Our analysis revealed that 60 of the 120 (50.0%) breast reconstruction candidates possessed the OA arising from a common trunk with the DIEA. The variant presented bilaterally in 27 (22.5%) patients and unilaterally in 33 (27.5%). CONCLUSIONS: The OA arises from the DIEA in half of our breast reconstruction cohort. This OA variant provides an improved size match with the DIEA compared to the lateral/medial row and allows for antegrade flow to both flaps, potentially optimizing perfusion. This anatomic variant has been utilized in 3 cases of stacked DIEP flap breast reconstruction with flap survival in all cases.