Muscle-sparing Deep Inferior Epigastric Perforator Research Articles

Immediate Autologous Breast Reconstruction Using Muscle-Sparing TRAM Flaps with Superficial Epigastric System Turbocharging: A Salvage Option

Current breast reconstruction trends favor the use of muscle-sparing abdominal flaps to minimize abdominal morbidity. When compared to the transverse rectus abdominis myocutaneous (TRAM) flap, the muscle-sparing deep inferior epigastric perforator (DIEP) flap and the superficial inferior epigastric artery (SIEA) flap are common options that minimize donor-site morbidity. For patients with inadequate flap perfusion via either system, alternative surgical options that permit preservation of the abdominal musculature are limited. Using both the DIEP and SIEA systems, the authors describe a turbocharged construct that also facilitates flap perfusion without the need for violation of the anterior rectus sheath. This turbocharged system can provide adequate blood supply in a flap with questionable DIEP or SIEA perfusion alone.

Radiation Effects on Breast Reconstruction: A Review

Breast cancer patients must make important decisions regarding whether or not to undergo breast reconstruction as well as what kind of reconstruction is best for them. A number of options for reconstruction are available, including saline or silicone prostheses, autologous transverse rectus abdominis muscle (TRAM) flaps, and autologous, muscle-sparing deep inferior epigastric perforator (DIEP) flaps. Even more difficult, however, is the decision if and when adjuvant radiation should be administered. The timing of radiation therapy can significantly affect the breast's final cosmetic and structural outcome. This article summarizes existing studies on how outcome is affected, with the conclusion that no reconstructive techniques are impervious to the damaging effects of postoperative radiation. However, there are numerous psychologic and economic benefits associated with immediate reconstruction. Depriving patients of these benefits is unnecessary when the likelihood of cancer recurrence is low. Together, surgeons, oncologists, and patients must first decide whether radiation is appropriate. Then they must assess the proper timing for its administration to achieve an outcome that is not only free of disease but also cosmetically acceptable.