Abstract: Stacked Lateral Thigh Perforator Flap (LTP) As a Novel Option for Autologous Breast Reconstruction (Plastic Surgery The Meeting (September 28

Monday, October 1, 2018: 8:15 AM

Oren Tessler, MD, MBA , Plastic and Reconstructive Surgery, Louisiana State University, New Orleans, LA

John Guste, MD , Division of Plastic Surgery, Louisiana State University Health Science Center, New Orleans, LA

Matthew Bartow, MD , Plastic Surgery, Louisiana State University, New orleans, LA

Radbeh Torabi, MD , Plastic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA

Alejandro R. Gimenez, BS , LSUHSC - New Orleans, New Orleans, LA

Shukan P Patel, MS , Louisiana State University Health Science Center, New Orleans, LA

Tim Matatov, MD , Plastic Surgery, Tulane University School of Medicine, New Orleans, LA

Rozbeh Torabi, MD , Aesthetic and Restorative Breast Center, Phoenix, AZ

Mark W Stalder, MD , Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA

Hugo St. Hilaire, MD, DDS , Division of Plastic and Reconstructive Surgery, Louisiana State University Health Science Center, New Orleans, LA

Robert J. Allen, MD , Plastic Surgery, Louisiana State University Health Science Center, New Orleans, LA

Introduction

The Deep Inferior Epigastric Artery Perforator (DIEP) flap is the gold standard in autologous breast reconstruction. When challenges such as insufficient tissue or prior surgeries exclude the abdomen as a potential donor site, alternate donor sites, including the buttock and thigh, as well as the use of stacked flaps can be considered. The Lateral Thigh Perforator Flap (LTPF) is an emerging candidate for autologous breast reconstruction, based on consistent and reliable septocutaneous vessels arising from the ascending branch of the lateral circumflex artery and the donor site location obviates the need for intraoperative repositioning. The flap is limited by the volume of soft tissue available for use as a single donor flap. An option to mitigate insufficient volume from a single flap is stacking two independent flaps as a single reconstruction unit. We present our experience performing stacked LTP flaps for unilateral breast reconstruction.

Methods

This is a retrospective review of patients undergoing unilateral breast reconstruction using stacked LTP flaps performed between June 2015 and November 2015. Data points were documented for each patient including: demographics, mastectomy resection weights, flap dimensions and weights, indications, complications, and surgical. Immediate post-operative complications including: flap failure, infection, wound dehiscence, seroma, hematoma, and donor site morbidity were recorded for each patient.

RESULTS:

Eight patients underwent delayed, unilateral breast reconstruction with stacked LTP flaps for a total of 16 flaps. Stacked flaps were anastomosed to anterograde and retrograde internal mammary vessels in all patients. The mean patient age was 47.3 years (range: 45-64 years); mean BMI was 26.2 kg/m² (range: 20.9-32.6 kg/m²). Two patients were current smokers while 5 patients noted significant alcohol use. Mastectomy specimen weights were only recorded for 5 of 8 patients, yielding an average mastectomy weight of 576.8 gm (range 221-826 gm). Mean flap weight was 333.1 gm (range 218-410 gm); and mean stacked weight of 636.9 gm (range 481-779 gm). The primary indications for using the LTP flap included insufficient abdominal wall tissue in 4 patients, absent deep inferior epigastric vessels secondary to prior surgical procedures unrelated to their reconstructions in 1 patient, and failed TRAM flaps in 3 patients.

Two patients developed a seroma at the donor site. There was no partial flap loss and no evidence of fat necrosis noted in follow-up examinations. Only one patient underwent a subsequent flap revision, Flap survival was 100% with no return to the OR in the immediate post-operative period.

DISCUSSION:

When the patient requires or prefers to have an autologous breast reconstruction, the stacked LTP flap should be considered an effective and viable option if the patient’s body habitus consists of excess lateral hip adiposity. The LTP flap has an anatomically reliable vascular supply that allows for a straightforward dissection, provides adequate volume and shape, and decreases operative time as 3 surgical teams can work simultaneously. The addition of the stacked LTP flap to the perforator flap collection allows the reconstructive surgeon to tailor breast reconstruction to the patient while focusing on body habitus and minimizing donor site deformity.

34437 Stacked Lateral Thigh Perforator Flap (LTP) As a Novel Option for Autologous Breast Reconstruction