Surgery Spotlight: DIEP Flap Breast Reconstruction-Surgery Spotlight: DIEP Flap Breast Reconstruction

Surgery Spotlight: DIEP Flap Breast Reconstruction

Video Transcription

Video Summary

In the video, Maurice Nahabedian, a plastic surgeon at Georgetown University Hospital, conducts a delayed breast reconstruction for a patient who had a left mastectomy and radiation therapy. The procedure is a DIEP (deep inferior epigastric perforator) flap reconstruction, which is detailed step-by-step. The operation involves dissecting the internal mammary vessels, identifying and preserving perforator vessels, and insetting the flap for the final outcome. The surgeon starts by marking the surgical area and using electrocautery to achieve hemostasis. Emphasizing the technique's importance in irradiated patients, he highlights the ease provided by healthy subcutaneous fat, which indicates less inflammation risk around the vessels.<br /><br />Nahabedian discusses the handling of internal mammary vessels and the challenges posed by radiation-induced fibrosis. The procedure underscores careful identification and management of perforators, demonstrating approaches to vessel dissection when they traverse muscle or a tendinous inscription. He also explains the implications of choosing lateral or medial perforators based on their vascular and neural proximity.<br /><br />Attention is given to safely dissecting and using perforator stems while minimizing muscle damage, stressing how preserving muscle function is crucial for patient recovery. Despite complexities like prior midline surgeries, the procedure achieves successful flap perfusion and shaping for aesthetic balance.<br /><br />Postoperative care includes monitoring, with an emphasis on mobilizing the patient early to facilitate recovery. Nahabedian concludes with observations about the technique's effectiveness, discussing potential anatomical challenges and solutions for successful outcomes in flap breast reconstruction.

Asset Caption

In this video, Maurice Nahabedian, MD performs a delayed left breast reconstruction using a deep inferior epigastric perforator (DIEP) flap reconstruction on a 43-year-old woman who has had prior radiation therapy. DIEP flaps are frequently chosen for autologous reconstruction because they can be harvested with no muscle and minimal fascial sacrifice. In this video, observe how Dr. Nahabedian marks the surgical site and begins his dissection. Once the internal mammary artery and vein are exposed, and the DIEP flap has been elevated watch Dr. Nahabedian's microsurgery technique as the new breast is reconstructed.

Surgeon Maurice Nahabedian, MD

Disclosure Dr. Nahabedian is a speaker for LifeCell Corporation/KCI. Dr. Shestak has nothing to disclose. Dr. Aly is a consultant, speaker and advisor for Ethicon/J&J; receives research support from Ethicon/J&J; is an advisor for Angiotech Pharamceuticals; is an advisor for and a shareholder with Incisive Surgical Inc.; and receives royalties from QMP. All ASPS staff members managing this activity have no relevant financial relationships or affiliations to disclose. All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials. This product is not certified for CME.

Keywords

surgery spotlight

Surgical Videos

Breast

Maurice Nahabedian MD; Memben

Maurice Nahabedian

Georgetown University Hospital

delayed breast reconstruction

left mastectomy

radiation therapy

DIEP flap

internal mammary vessels

perforator vessels

electrocautery

radiation-induced fibrosis

muscle preservation

postoperative care