Beyond the DIEP Flap: Thigh-Based Autologous Breast Reconstruction | Journal CME Article-Journal CME Article: Beyond the DIEP Flap: Thigh-Based Autologous Breast Reconstruction (Article)

Journal CME Article: Beyond the DIEP Flap: Thigh-Based Autologous Breast Reconstruction (Article)

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This article reviews thigh-based free flaps as alternatives for autologous breast reconstruction, especially when abdominal flaps such as the DIEP are not suitable because of prior surgery, inadequate abdominal tissue, or patient preference. The main thigh-based options discussed are the gracilis myocutaneous flap (TUG, DUG, VUG), the profunda artery perforator (PAP) flap, and the lateral thigh perforator (LTP) flap.<br /><br />Thigh flaps can offer good shape, reasonable volume for selected patients, and the advantage of a two-team harvest without repositioning. However, they generally provide less tissue than abdominal flaps and may require stacked flaps, implants, or fat grafting for larger reconstructions. Donor-site concerns include visible scars, contour irregularities, sensory changes, lymphedema risk, wound healing problems, and, for the LTP, a higher complication rate than some medial/posterior thigh options.<br /><br />Patient selection and counseling are emphasized. Ideal candidates often have lower BMI, thigh laxity, or prior abdominal surgery. Surgeons should assess vascular status, skin redundancy, fat distribution, and patient preferences about scar location. Preoperative CTA is especially helpful for PAP planning.<br /><br />Each flap has distinct advantages: gracilis flaps are fast and reliable but smaller and sacrifice muscle; PAP flaps provide a longer, larger-caliber pedicle and strong perfusion; LTP flaps can provide useful volume in patients with lateral thigh excess. The article also reviews markings, operative positioning, inset strategies, and donor-site closure techniques to improve outcomes.<br /><br />Overall, the authors conclude that thigh-based flaps are safe, reliable, and increasingly important options for complex breast reconstruction when abdominal or flank donor sites are unavailable.

Keywords

thigh-based free flaps

autologous breast reconstruction

DIEP flap alternatives

profunda artery perforator flap

gracilis myocutaneous flap

lateral thigh perforator flap

patient selection

donor-site complications

preoperative CTA

breast reconstruction options