Modern approaches to alternative flap-based breast reconstruction: stacked deep inferior epigastric perforator flaps

Autologous breast reconstruction has greatly evolved with the introduction of stacked deep inferior epigastric perforator (DIEP) flaps, providing a sophisticated option for patients with insufficient donor tissue or those requiring substantial breast mounds. This technique utilizes either conjoined/bipedicled or separate abdominal flaps to recreate the breast with natural-looking results and high satisfaction rates. Preoperative planning is critical, involving detailed vascular mapping to ensure successful outcomes. Despite the complexity of the procedure, the complication profile remains comparable to non-stacked methods, with a notable reduction in fat necrosis and no significant increase in overall risk. Similar to the DIEP flap, possible complications related to the stacked DIEP flap include donor-site morbidity such as abdominal bulge or hernia, and complications at the recipient site such as flap ischemia or fat necrosis. The stacked DIEP flap technique has improved the symmetry and volume matching of reconstructed breasts while maintaining abdominal integrity, marking a significant advancement in the field that aligns with the aesthetic aspirations of patients undergoing mastectomy.