The Stacked Hemi-Abdominal Extended Perforator (SHAEP) flap for autologous breast reconstruction.

BACKGROUND: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemi-abdominal extended perforator (SHAEP) flap. We described the surgical technique and analyzed our results.

METHODS: A prospective study was conducted of all SHAEP flap breast reconstructions performed since February 2014. Patient demographics, operative details, complications and flap re-explorations were recorded. The bipedicled hemi-abdominal flap was designed as a combination of the deep inferior epigastric perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels (DCIA/SCIA), the superficial inferior epigastric artery (SIEA), or a lumbar artery or intercostal perforator.

RESULTS: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range 405-797). Median hemi-abdominal flap weight that was used for reconstruction was 598 grams (range 160-1389). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2%), hematoma (3.3%), fat necrosis (2.2%), and wound problems (4.4%). Minor donor-site complications occurred in five patients (10.2%). Most flaps were harvested on a combination of the DIEP and DCIA vessels.

CONCLUSIONS: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site.