The Stacked Hemi-Abdominal Extended Perforator (SHAEP) flap for autologous breast reconstruction

Background: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemi-abdominal extended perforator (SHAEP) flap. We described the surgical technique and analyzed our results. Methods: A prospective study was conducted of all SHAEP flap breast reconstructions performed since February 2014. Patient demographics, operative details, complications and flap re-explorations were recorded. The bipedicled hemi-abdominal flap was designed as a combination of the deep inferior epigastric perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels (DCIA/SCIA), the superficial inferior epigastric artery (SIEA), or a lumbar artery or intercostal perforator. Results: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range 405-797). Median hemi-abdominal flap weight that was used for reconstruction was 598 grams (range 160-1389). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2%), hematoma (3.3%), fat necrosis (2.2%), and wound problems (4.4%). Minor donor-site complications occurred in five patients (10.2%). Most flaps were harvested on a combination of the DIEP and DCIA vessels. Conclusions: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site. Financial disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Conflicts of interest: None. Funding: None. Trial registration: Not applicable. Acknowledgements: The authors would like to acknowledge Dr. Edward Buchel for his great work on the DCIA flap as a combined flap with the DIEP or SIEA, which was the foundation for the SHAEP flap. Corresponding author: Joshua L. Levine, M.D., Center for Breast Reconstruction, 3 Columbus Circle #1410, New York, NY 10019, United States of America. Phone: 212 – 245 – 8140. Fax: 212 – 245 – 8157. Email: info@joshualevinemd.com ©2018American Society of Plastic Surgeons