REFINEMENTS IN FREE-FLAP BREAST RECONSTRUCTION - THE FREE BILATERAL DEEP INFERIOR EPIGASTRIC PERFORATOR FLAP ANASTOMOSED TO THE INTERNAL MAMMARY ARTERY

Besides the enormous advantages of reconstructing the amputated breast by means of a conventional TRAM flap, the main disadvantage remains t he elevation of small (free TRAM) or larger (pedicled TRAM) parts of t he rectus abdominis muscle. In order to overcome this disadvantage, th e free Deep Inferior Epigastric Perforator (DIEP) skin flap has recent ly been used for breast mound reconstruction with excellent clinical r esults. After achieving favorable results with eight unilateral DIEP-f laps, we were challenged by an abdomen with a midline laparotomy scar. By dissecting a bilateral DIEP flap and making adjacent anastomoses t o the internal mammary artery we were able to achieve sufficient flap mobility for easy free flap positioning and breast shaping. Intraopera tive segmental nerve stimulation, postoperative functional abdominal w all tests and CT-scan examination showed normal abdominal muscle activ ity. On the basis of a case report, the technical considerations and a dvantages of anastomosing the bipedicled DIEP flap to the internal mam mary artery are discussed.