The advancements in our understanding of anatomy combined with surgical expertise have allowed us to improve the field of autologous breast reconstruction by using perforator-based free flaps. Free flaps are tissue in the body that has preserved blood supply. However, contrary to pedicled flaps, the blood supply is disconnected at its source and reconnected to vessels in the chest using microsurgical techniques. This allows the free transportation of tissue from one part to a distant part of the body.
We describe the perforator flap options below; however, we will briefly describe the deep inferior epigastric artery perforator (DIEP) flap in this area. The DIEP is the most popular option for perforator-based free flaps due to breast size and shape similarities.
This is similar to the tissue used in the rectus abdominus pedicled flap. However, studies have shown that the dominant blood supply to this tissue comes from an inferior source (iliac vessels). In contrast, the pedicled flap is based on superior vessels. This is also similar to the tissue removed in an abdominoplasty (tummy-tuck).
By freely transporting tissue on its main blood supply, autologous reconstruction results have decreased donor site morbidity. The goal is to preserve the underlying muscle that the perforator vessels travel through. Disadvantages of free flap breast reconstruction include the donor site risks, length of procedure, and availability of microsurgical team and capability.