The application of double pedicled free deep inferior epigastric artery perforator flap breast reconstruction following mastectomy in unilateral breast cancer

This study aims to elucidate the technical points of double pedicled free deep inferior epigastric perforator (DIEP) breast reconstruction for breast cancer patients with large and ptotic breast. A retrospective analysis was conducted on patients who underwent DIEP flap breast reconstruction between January 2022 to December 2023, of which 92 immediate breast reconstructions using DIEP flap were included in this study. There were 21 cases underwent double-pedicled DIEP and 71 cases underwent unilateral pedicled DIEP. Using the internal thoracic vessels were employed for vascular anastomosis, and in the double pedicled DIEP group, 21 flaps survived while in the unilateral group 70 cases survived. The satisfaction degree of the double pedicled group was higher than that of the unilateral-pedicled group. In the double pedicled group, there was 0 case with moderate to severe radiation dermatitis, compared to 12 cases in the unilateral group. The double pedicled DIEP group tended to explore obviously higher biopsy rate (47.6%) of unexpected discovery internal mammary lymph nodes (IMLNs) than the unilateral pedicled group (16.9%). However, there was no significant difference (P=0.058) of the metastatic rate of IMLNs in the double pedicled group (50%) compared with that in the unilateral-pedicled group (25%). Clinically, for patients with large and sagging breasts, those requiring IMLN biopsy, those seeking to reduce side effects such as radiation-induced dermatitis, and those needing to ensure adequate blood supply to the flap, the double-tissue DIEP breast reconstruction surgery is an extremely effective autologous breast reconstruction method.