Simultaneous Circumferential Body Lift and Four-Flap Breast Reconstruction Using Deep Inferior Epigastric Perforator and Lumbar Artery Perforator Flaps

The ideal autologous breast reconstruction provides a long-lasting and aesthetically pleasing result. The deep inferior epigastric perforator (DIEP) flap remains the gold standard for breast reconstruction; however, in a subset of patients, this flap may not provide adequate soft tissue to achieve the patient's aesthetic goals. The lumbar artery perforator flap has emerged as a useful adjunct to the DIEP flap for four-flap breast reconstruction, and also provides the patient with circumferential body contouring. From April 1 to July 1, 2019, the authors performed two bilateral stacked DIEP and lumbar artery perforator flap breast reconstructions. The authors retrospectively reviewed patient charts for pertinent data. Patients were chosen for reconstruction based on their physical examination and computed tomographic angiography findings. The operative technique used was unchanged for both reconstructions. The average total length of surgery was 553 minutes. The average DIEP flap weight was 510 g and the average lumbar artery perforator flap weight was 680 g. The average ischemia time for each lumbar artery perforator flap was 62 minutes. Length of stay was 3 days for both patients. This article describes the authors' approach to total breast reconstruction with stacked lumbar artery perforator flaps and DIEP flaps while also effectively performing a circumferential lower body lift. Critical components for success include appropriate patient selection and using a team approach with appropriately experienced staff at all levels of care.