ABSTRACT
There are numerous pre- and peri-operative decisions for a reconstructive surgeon to make when considering free tissue transfer for breast reconstruction. The most commonly used abdominal free flap, known as the deep inferior epigastric perforator flap is introduced as an example to explain the operative principles involved in free tissue transfer. This chapter discusses some of the specific factors, in addition to general health and co-morbidity, which are relevant to any discussion about autologous breast reconstruction. The elevation of the abdominal flap then proceeds from lateral to medial in the loose areolar plane at the level of deep fascia. Skilled nursing care is vital during the post-operative period because free flaps require intensive monitoring. In order for the flap to remain well perfused, both venous outflow and arterial inflow are required. Finally, patient satisfaction, as measured by validated quality-of-life scores (Breast-Q) is consistently higher following autologous reconstructions compared with implant-based procedures.
