In recent years, medical advancements in breast reconstruction have provided numerous options for women who have undergone mastectomy or have congenital breast abnormalities. One such technique is stacked deep inferior epigastric perforator (DIEP) with sequential lumbar artery perforator (LAP) flaps. This case report discusses the successful implementation of this technique in a 39-year-old female patient with bilateral heterogeneous breast cancer.

What is Stacked Deep Inferior Epigastric Perforator with Sequential Lumbar Artery Perforator Flaps?

The stacked deep inferior epigastric perforator with sequential lumbar artery perforator flaps is a surgical technique used for bilateral breast reconstruction. It involves using a combination of tissues from the abdomen and lower back to create breast mounds. The deep inferior epigastric perforator (DIEP) flap is a commonly used technique that utilizes a blood vessel called the deep inferior epigastric artery to provide a blood supply to the newly reconstructed breast. In cases where the patient’s thigh is too thin or the use of gluteal tissue is not preferred, the sequential lumbar artery perforator (LAP) flap can be used as an alternative source of tissue, providing additional volume to the breasts.

What is the Purpose of Bilateral Breast Reconstruction?

Bilateral breast reconstruction is a procedure aimed at restoring the shape, size, and symmetry of both breasts after mastectomy or congenital abnormalities. It helps improve the psychological well-being and self-confidence of women who have undergone breast removal surgery. Additionally, it provides a sense of normalcy and alleviates the physical challenges that come with the loss of breast tissue. By using the stacked DIEP with sequential LAP technique, surgeons can achieve optimal outcomes for patients with larger breast size requirements.

What was the Patient’s Medical History?

The patient in this case report was a 39-year-old female with bilateral heterogeneous breast cancer. She had undergone total mastectomy and radiation therapy on the left side and nipple sparing mastectomy on the right side. Given her thin physique and refusal to use gluteal tissue, the stacked DIEP with sequential LAP technique was deemed suitable for her bilateral breast reconstruction.

The surgical procedure involved harvesting the DIEP and LAP flaps as one continuous flap. The flap dimensions were 10 cm wide at the abdomen, 5 cm wide at the waist, and 72 cm long overall. The lumbar artery and vein were anastomosed to the distal stump of the deep inferior epigastric artery and vein within the flaps. Subsequently, the proximal stump of the deep inferior epigastric artery and vein was anastomosed to the internal mammary artery and vein.

The LAP flaps were placed deeply, while the DIEP flaps were placed superficially. De-epithelialization of the entire skin was performed on the right side, and damaged skin from radiotherapy was replaced with abdominal skin on the left side. The patient experienced a fully successful flap survival, achieving good breast shape, and maintaining the body line on the donor side.

This case report demonstrates the effectiveness of the stacked DIEP with sequential LAP technique as a viable option for thin patients requiring bilateral breast reconstruction. The combination of tissues from the abdomen and lower back ensures an adequate volume of tissue is available, resulting in natural and symmetric breast reconstruction.

Implications and Future Directions

The use of the stacked DIEP with sequential LAP technique has implications for both patients and surgeons. For patients, it offers a wider range of options for breast reconstruction, particularly for those with larger breast size requirements. By utilizing different areas of the body, this technique provides the necessary volume to achieve a natural-looking and balanced outcome.

For surgeons, this technique expands the repertoire of available methods for breast reconstruction. It allows them to tailor the surgical plan based on individual patient needs and physiques, resulting in customized and optimal outcomes. The success of this case report encourages further exploration and research into the technique, ensuring its continued advancement in the field of breast reconstruction.

Overall, the stacked deep inferior epigastric perforator with sequential lumbar artery perforator flaps technique presents a promising option for bilateral breast reconstruction in thin patients requiring large-volume breast reconstruction. By combining different tissue sources and utilizing advanced microsurgical techniques, surgeons can achieve successful outcomes that meet patients’ aesthetic goals and improve their quality of life.

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Disclaimer: While I have a passion for health, I am not a medical doctor and this is not medical advice.

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