Simultaneous expander and deep inferior epigastric perforator reconstruction: indications and alloderm sling technique for protecting the anastomosis

Aim: Autologous tissue is considered the gold standard for breast reconstruction today. However, little is known about deep inferior epigastric perforator (DIEP) flap reconstruction in combination with tissue expander (TE)/implant. The authors describe a series of combined DIEP flap/TE reconstruction, including its indications and technique to ensure protection of the pedicle during the expansion process. Methods: Between January 2009 and December 2012, patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed. Oncologic, comorbid conditions, intraoperative, postoperative expansion, complications, and technique data points were collected. Photographs were taken postoperatively and patient's satisfaction surveys were obtained to assess overall satisfaction. Results: Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique. There were no complications to the pedicle, flap, expander, or mastectomy skin perioperatively or postoperatively. All patients describe being very satisfied, often with improved breast volume and projection as compared to their preoperative appearance. Conclusion: The results of this study suggest that DIEP flap/TE reconstruction is safe, in particular when utilizing the alloderm sling technique, and should be considered in patients who lack sufficient abdominal tissue, have existing breast asymmetries, or do not desire the scar deformity of latissimus dorsi.