Sensated Conjoined DIEP Flaps and Vascularized Lymph Node Transfer: Ferrari Flap

Abstract

Introduction: Alloplastic reconstruction is still the most common choice, but it has been shown that using the patient’s own tissue creates a more natural breast that needs less surgery in the long term and makes the patient satisfied. Patients with lymphedema, and insufficient abdominal tissue following mastectomy require two pedicle flaps to optimize the volume of the deficient abdominal tissue. Materials and Methods: Only 5 patients who had unilateral breast reconstruction with a neurotized conjoined DIEP flap and simultaneous lymph node transfer (Ferrari flap) were included in the study. Two patients underwent nipple sparing mastectomy, two simple mastectomy and one skin sparing mastectomy. Nerve conduit was utilized in 4 of the 5 patients, The remaining flap was neurotized by direct coaptation of the 3rd anterior ICN and the cutaneous branch of the T11 ICN of the DIEP flap. Flap included concurrent groin lymph node transfer. Results: Five patients underwent Ferrari flap breast reconstruction. The mean BMI was 23.0 (21.0 to 24.9). Average operative time was 6 hours and 8 minutes. Mean hospital length of stay was 3.5 days. All the patients in our study had clinically diagnosed lymphedema secondary to previous oncologic surgery, and after surgery, 4 patients had resolution of the lymphedema. Only one patient continued to have stage 1 to 2 lymphedema and is being treated with compression sleeves and physical therapy. There were no complications with the flaps. Conclusion: Autologous unilateral breast reconstruction with neurotized conjoined DIEP flap and lymph node transfer (Ferrari flap) can be performed safely and reliably with high success rates in the hands of experienced surgeons and affords patients the best option for achieving an aesthetic, natural breast reconstruction as well as addressing their lymphedema and sensation in a single operation. This combined surgical technique provides great outcomes and significantly improves the patient’s quality of life.