Bipedicle Deep Inferior Epigastric Perforator Flap for Unilateral Breast Reconstruction: Seven Years' Experience

Background: The deep inferior epigastric perforator (DIEP) flap has recently gained popularity as a breast reconstruction technique; however, insufficient blood supply, which can be augmented by the bipedicle flap, is its major drawback. Methods: The authors analyze a consecutive series of DIEP flaps performed over 7 years and propose a strategy that includes three options for reconstructing the blood supply of the bipedicle flap. Results: One hundred thirteen patients aged 20 to 56 years (mean, 41.9 years) underwent unilateral breast reconstruction with 96 bipedicle and 17 unipedicle DIEP flaps. The three options the authors proposed to reconstruct the blood supply of the bipedicle flap were applied in 94 patients. The mean follow-up period was 12.4 months. Two flaps were lost in the bipedicle group and one flap was lost in the unipedicle group (p = 0.721). One patient developed partial flap loss in the bipedicle group and three patients developed partial flap loss in the unipedicle group (p = 0.011). The overall fat necrosis occurred in 12 patients in the bipedicle group and eight patients in the unipedicle group (p = 0.02). Complications occurred in the abdomen in four patients in the bipedicle group and one patient in the unipedicle group (p = 0.565). One patient (0.9 percent) in the bipedicle group complained of abdominal asymmetry. No hernia occurred during the follow-up period. Conclusions: Bipedicle DIEP flap surgery for unilateral breast reconstruction is a safe and acceptable procedure, especially for patients who have midline infraumbilical incisional scars. With the strategy and options the authors present, the blood supply of the bipedicle DIEP flap can be easily reconstructed in all situations. (Plast. Reconstr. Surg. 124: 1797, 2009.)