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J Reconstr Microsurg
DOI: 10.1055/a-2717-4996
Original Article

Clinical Scenarios Using Thoracodorsal and Lateral Thoracic Vessels Versus Internal Mammary Vessels in Bipedicled Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Comparative Study

Authors

  • Chia-Fang Chen 

    1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

  • David Chon-Fok Cheong 

    1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

  • Wen-Ling Kuo 

    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    4   Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    5   School of Medicine, National Tsing Hua University, Hsinchu, Taiwan

  • Chi-Chang Yu 

    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    4   Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

  • Hsu-Huan Chou 

    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    4   Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

  • Shin-Cheh Chen 

    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    4   Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

  • Jung-Ju Huang 

    1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
    2   College of Medicine, Chang Gung University, Taoyuan, Taiwan
    3   Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

Funding Information This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background

Autologous breast reconstruction using the bipedicled deep inferior epigastric perforator (DIEP) flap poses unique challenges in Asian patients with a low BMI and limited donor volume. While internal mammary vessels (IMA/Vs) remain the standard recipient site, the rise of minimally invasive mastectomy has limited access to IMA/Vs. This study compared the results of thoracodorsal and lateral thoracic vessels (lateral-based) versus IMA/Vs (medial-based) in bipedicled DIEP flap breast reconstruction.

Methods

A retrospective review was conducted on 62 patients who underwent bipedicled DIEP flap reconstruction between 2018 and 2023 by a single senior surgeon. Patients were stratified by incision placement and recipient vessel choice into medial- and lateral-based groups. Clinical outcomes, complication rates, and long-term aesthetic results were analyzed.

Results

Despite a higher re-exploration rate in the lateral-based group (12.5% versus 4.5%; p = 0.298), flap survival was comparable between the groups. Fat necrosis rates were lower in flaps without re-exploration (5.4%) and increased significantly following compromised perfusion (33.3%). The lateral-based group achieved superior aesthetic outcomes in breast shape (p = 0.043) and scar visibility (p < 0.001), with a reduced need for secondary fat grafting. Dual vascular sources provided more reliable perfusion and improved long-term fat survival, although further validation with perfusion imaging is warranted.

Conclusion

The lateral-based approach, despite technical challenges, is a viable alternative to the medial-based method in certain patients, offering reliable perfusion and superior aesthetic outcomes with fewer revisions. An algorithmic approach to recipient vessel selection can optimize outcomes of bipedicled DIEP flap reconstruction.

Keywords

mastectomy - device-assisted mastectomy - autologous breast reconstruction - bipedicled DIEP flap - internal mammary vessels - thoracodorsal vessels - lateral thoracic vessels

Data Availability Statement

The raw datasets generated within this study are available from the corresponding author on reasonable request.


Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board of Chang Gung Medical Foundation (IRB number: 202301830B0).


Supplementary Material



Publikationsverlauf

Eingereicht: 14. Juni 2025

Angenommen: 21. September 2025

Artikel online veröffentlicht:
28. Oktober 2025

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