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Nevertheless, large breast reconstruction still remains a challenge for the surgeons because the amount of fat that could be safely transferred with the DIEP and SIEA flaps in the conventional way could be insufficient to achieve a good symmetry with the contralateral breast. A contralateral reduction mammaplasty may solve some of these cases, but in other clinical situations a flap larger than standard is needed. This fact gains importance especially in patients with scant abdominal tissue or infraumbilical vertical scars, and in delayed reconstructions after previous modified radical mastectomy (MRM) where there is a severe lack of skin and subcutaneous tissue. Moreover, patients who previously had mastectomy plus expander breast reconstruction often show a depression of the cartilage rib cage which could need larger flap to be corrected.

Double-Pedicle DIEP and SIEA Flaps and Their Application in Breast Reconstruction