J Reconstr Microsurg 2014; 30(02): 121-126
DOI: 10.1055/s-0033-1357272
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Evolution of Perforator Flap Breast Reconstruction: Twenty Years after the First DIEP Flap

Claragh Healy
1  St. Andrew's Centre for Burns and Plastics, Broomfield Hospital, Chelmsford, United Kingdom
Robert J. Allen Sr.
2  Department of Plastic Surgery, New York University Langone Medical Centre, New York and Louisiana Health Sciences Centre, Louisiana
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14. Juni 2013

12. August 2013

25. Oktober 2013 (online)


It is over 20 years since the inaugural deep inferior epigastric perforator (DIEP) flap breast reconstruction. We review the type of flap utilized and indications in 2,850 microvascular breast reconstruction over the subsequent 20 years in the senior author's practice (Robert J. Allen). Data were extracted from a personal logbook of all microsurgical free flap breast reconstructions performed between August 1992 and August 2012. Indication for surgery; mastectomy pattern in primary reconstruction; flap type, whether unilateral or bilateral; recipient vessels; and adjunctive procedures were recorded. The DIEP was the most commonly performed flap (66%), followed by the superior gluteal artery perforator flap (12%), superficial inferior epigastric artery perforator flap (9%), inferior gluteal artery perforator flap (6%), profunda artery perforator flap (3%), and transverse upper gracilis flap (3%). Primary reconstruction accounted for 1,430 flaps (50%), secondary 992 (35%), and tertiary 425 (15%). As simultaneous bilateral reconstructions, 59% flaps were performed. With each flap, there typically ensues a period of enthusiasm which translated into surge in flap numbers. However, each flap has its own nuances and characteristics that influence patient and physician choice. Of note, each newly introduced flap, either buttock or thigh, results in a sharp decline in its predecessor. In this practice, the DIEP flap has remained the first choice in autologous breast reconstruction.