Abstract:

Objective

In the past decade， there has been increasing breast reconstruction after mastectomy.The ideal material for reconstruction of a breast is fat and skin.The Transverse Rectus Abdominis Myocutaneous （TRAM） flap has been the gold standard for breast reconstruction recently.Abdominal wall function is a major concern for plastic surgeon in breast reconstruction with TRAM flaps.The deep inferior epigastric perforator （DIEP） free flap spares the whole rectus abdominis muscle， includes skin and fat only， therefore preserves adequate abdominal wall competence.

Methods

Between March， 2000 and May，2005， a total of 47 breast reconstruction in 44 patients were performed by using the DIEP flap.3 patients had bilateral procedures.17 breast reconstructions were immediate and 27 were delayed.All patients were collected prospectively and no patients were excluded from this study.Abdomianl function， satisfaction with the donor site and reconstructed breast and the sensation recovery are assessed respecticvely in the follow-up.

Results

The average age of patients was 38.6 years （range， 28-50 years）.The size of the flaps were ranged from 11 cm×26 cm （Range height 10 -12 cm， width 15 -33 cm）.The mean length of vascular pedicle was 9.3 cm（range，7-12 cm）.The mean postoperative follow-up period was 16 months （range，3 to 30 months）.Total flap loss and partial necrosis occued in 2 flaps （4% ） perspectively.Wound edge necrosis in abdoman occured in 4 patients（9% ）.Axillary seroma occurd in 1 patient.Postoperative abdominal wall examination did not reveal any hernia.All patients were able to resume their daily activities.Abdominal Scar directly affect the satisfaction with the whole abdominal wall.Patient satisfaction with the reconstructed breast rated high.Spotaneous sensation return in reconstructed breast is 95% ， but no one is equivalen or apporximate to normal.

Conclusions

The data indicate that the free DIEP flap is a new reliable and safe technique for autologous breast reconstruction.This flap offers the patients the same advantages as the TRAM flap and discards the disadvantages of the myocutaneous flap by preserving the continuity of the rectus muscle.The DIEP flap reduces donor site morbidity and is able to provide an aesthetic refinement in breast reconstruction， despite the technically more difficult dissection.

Key words: Breast reconstruction, Perforator flap, DIEP flap