Robert Allen, MD, and Brenda Mahon-Deri, MD.
Department of Surgery, Division of Plastic Surgery, Louisiana State University Medical Center, New Orleans.
Since 1992, the LSU Division of Plastic Surgery has done 30 deep inferior epigastric perforator (DIEP) flaps for bilateral breast reconstruction. A majority of these procedures were done simultaneously. The staged reconstructions were usually separated by a 1-week period. The donor site morbidity associated with the TRAM flap has been well documented, including bulging and hernias of the abdominal wall.
These problems are exaggerated with bilateral TRAMs. With perforator flaps, there is no anterior rectus sheath or muscle sacrificed, therefore one would expect decreased donor site morbidity. Our series reports no abdominal hernias or bulges postoperatively. Preoperative and postoperative rectus muscle studies are being done. Patient questionnaires on donor site morbidity are being reviewed. We believe that our DIEP flap offers significant improvements in donor site morbidity compared with the traditional TRAM.