Stacked DIEP and Implant for Unilateral Breast Reconstruction

Abstract

The Deep Inferior Epigastric Perforator (DIEP) fl ap is the preferred method of autogenous breast reconstruction as it provides an ideal replacement for the absent breast tissue with minimal donor site morbidity and improved abdominal contour. When a single hemiabdomen is inadequate for unilateral reconstruction the volume and projection can be augmented with an implant, or the experienced microsur-geon may offer stacked DIEP fl aps. 1 An additional considera-tion would be the use of both hemiabdominal fl aps in addition to an implant. This hybrid combination could max-imize the autogenous contribution to the reconstruction allowing the use of a smaller implant. Additionally, total implant coverage with stacked DIEP fl aps could help prevent rippling, improve projection, and lessen implant palpability. We describe two cases of hybrid reconstruction combining stacked DIEP fl aps with immediate silicone implantation to improve reconstructive outcomes.