Deep Inferior Epigastric Perforator Flap in Breast Reconstruction: Egyptian Experience

Breast reconstruction after mastectomy operations has been an increasingly demanded operation in the current years. Patient awareness of the psychological advantages, and the versatility of the techniques utilized in breast reconstruction have been overwhelmingly emphasized over the last two decades. Also, the advances in early diagnosis and management of breast cancer have made the operation a highly requested one, especially among young females.

A multitude of procedures have been used in breast reconstruction. Breast implants were initially introduced, but were associated with significantly high complication rates. This was followed by the introduction of the pedicled flaps, e.g.,the pedicled latissmus and the pedicled TRAM flaps in breast reconstruction. Understanding of the vascular anatomy of the lower anterior abdominal wall has paved the way for the utilization of the free TRAM flap as a superior alternative to the pedicled TRAM flap in breast reconstruction. The deep inferior epigastric perforator flap has evolved from the free TRAM. The procedure involves the same principles and technique used in the free TRAM, while basing the flap on one or two direct paraumbilical perforators connected to the deep inferior epigastric artery. Retaining the integrity of the anterior abdominal wall by using the flap has been reported to be associated with a lower incidences of incisional hernia and abdominal bulge.

In this paper the author presented experience in breast reconstruction using the deep inferior epigastric artery perforator flap. The indications, timing, and advantages of the technique in breast reconstruction were discussed. Donor–site morbidity was subjectively evaluated. The final cosmetic results of the breast reconstruction were evaluated and examined against patients' expectations.