Breast reconstruction with a neurotized DIEP flap

The most frequent cause of mastectomy (mammary resection) is due to breast cancer. In summary, there are two ways to reconstruct a breast, either with tissue from the same patient, which is known as autologous reconstruction, or with implants, which is known as alloplastic reconstruction.

The best reconstruction quality from the functional and aesthetic point of view is achieved in the tissue reconstruction of the same patient. This avoids the use of implants that, in the scenario of a breast reconstruction, and not of an aesthetic mammary augmentation, have a high rate of complications, with greater risk of extrusion, infection, capsular contracture, and poor aesthetic result.

Within the breast reconstruction options with the patient’s own tissue, the current gold standard is mammary reconstruction with a neurotized DIEP microsurgical free flap (Deep Inferior Epigastric Perforator). In this reconstruction the same abdominal tissue is used that is resected in an aesthetic abdominoplasty, with the difference that the blood vessels (perforators) that cross the rectus abdominis muscle and that are connected to the deep inferior epigastric vessels are preserved and dissected. This tissue, made up of skin and fat with a texture similar to that of a breast, is transferred with the help of microsurgery to reconstruct the breast. Finally, the sensitive nerves of the transplanted tissue are connected, which improves the recovery of sensitivity and even in some cases to recover the erogenous sensibility.

Microsurgical reconstruction is especially indicated when there is prior radiotherapy. In these cases the use of expander and prosthesis have an unacceptable complication rate.
El colgajo DIEP neurotizado es una cirugía bastante estandarizada, pero debe ser realizada por un microcirujano entrenado, sobre todo en colgajo de perforantes. Esto con el objetivo de lograr la mejor posibilidad de éxito de la cirugía en término de sobrevida del colgajo (que no fallen las conexiones microvasculares) y de minimizar la morbilidad de la zona donante (pared abdominal), preservando el musculo recto abdominal en su totalidad y además preservando la inervación motora del musculo. Un efecto secundario beneficioso de esta zona donante es la mejoría estética de la zona abdominal por la  “abdominoplastía” necesaria para realizar la reconstrucción.

Alejandro Ramírez