{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:25:43Z","timestamp":1787009143748,"version":"build-2736575974"},"reference-count":38,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Autologous breast reconstruction using the bipedicled deep inferior epigastric perforator (DIEP) flap poses unique challenges in Asian patients with a low BMI and limited donor volume. While internal mammary vessels (IMA\/Vs) remain the standard recipient site, the rise of minimally invasive mastectomy has limited access to IMA\/Vs. This study compared the results of thoracodorsal and lateral thoracic vessels (lateral-based) versus IMA\/Vs (medial-based) in bipedicled DIEP flap breast reconstruction.<\/jats:p>\n                  <jats:p>A retrospective review was conducted on 62 patients who underwent bipedicled DIEP flap reconstruction between 2018 and 2023 by a single senior surgeon. Patients were stratified by incision placement and recipient vessel choice into medial- and lateral-based groups. Clinical outcomes, complication rates, and long-term aesthetic results were analyzed.<\/jats:p>\n                  <jats:p>Despite a higher re-exploration rate in the lateral-based group (12.5% versus 4.5%; p\u2009=\u20090.298), flap survival was comparable between the groups. Fat necrosis rates were lower in flaps without re-exploration (5.4%) and increased significantly following compromised perfusion (33.3%). The lateral-based group achieved superior aesthetic outcomes in breast shape (p\u2009=\u20090.043) and scar visibility (p\u2009&lt;\u20090.001), with a reduced need for secondary fat grafting. Dual vascular sources provided more reliable perfusion and improved long-term fat survival, although further validation with perfusion imaging is warranted.<\/jats:p>\n                  <jats:p>The lateral-based approach, despite technical challenges, is a viable alternative to the medial-based method in certain patients, offering reliable perfusion and superior aesthetic outcomes with fewer revisions. An algorithmic approach to recipient vessel selection can optimize outcomes of bipedicled DIEP flap reconstruction.<\/jats:p>","DOI":"10.1055\/a-2717-4996","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:07:27Z","timestamp":1761696447000},"page":"566-574","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Scenarios Using Thoracodorsal and Lateral Thoracic Vessels Versus Internal Mammary Vessels in Bipedicled Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Comparative Study"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2911-7547","authenticated-orcid":false,"given":"Chia-Fang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1430-7348","authenticated-orcid":false,"given":"David Chon-Fok","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1145-8514","authenticated-orcid":false,"given":"Wen-Ling","family":"Kuo","sequence":"additional","affiliation":[{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"School of Medicine, National Tsing Hua University, Hsinchu, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2565-4305","authenticated-orcid":false,"given":"Chi-Chang","family":"Yu","sequence":"additional","affiliation":[{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0948-1141","authenticated-orcid":false,"given":"Hsu-Huan","family":"Chou","sequence":"additional","affiliation":[{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0177-0045","authenticated-orcid":false,"given":"Shin-Cheh","family":"Chen","sequence":"additional","affiliation":[{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-7834","authenticated-orcid":false,"given":"Jung-Ju","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref1","volume-title":"Cancer Registry Annual Report, Republic of China, 1995","year":"1997"},{"key":"ref2","volume-title":"Cancer Registry Annual Report, Taiwan, 2020","year":"2022"},{"key":"ref3","volume-title":"Survival Analysis of Cancer Patients in Taiwan. 2017\u20132021","year":"2023"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1007\/s12282-020-01076-1","article-title":"Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis","volume":"27","author":"S Zehra","year":"2020","journal-title":"Breast Cancer"},{"key":"ref5","first-page":"3877984","article-title":"Quality of life in patients with breast cancer following breast conservation surgery: a systematic review 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outcomes in unilateral and bilateral abdominal flap breast reconstruction: a meta-analysis","volume":"99","author":"Z Cao","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"03","key":"ref38","doi-asserted-by":"crossref","first-page":"e4840","DOI":"10.1097\/GOX.0000000000004840","article-title":"Bulging after DIEP breast reconstruction: new insights concerning rectus diastasis and medial perforator harvest","volume":"11","author":"S H Nelissen","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"}],"container-title":["Journal of Reconstructive 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