Microvascular autologous breast reconstruction with the lateral thigh perforator flap

The lateral thigh perforator flap is an excellent alternative to the deep inferior epigastric artery perforator (DIEP) flap for patients with absolute or relative contraindications for a DIEP flap and adequate volume at the lateral thigh. Preoperative physical examination, preoperative markings, and radiological perforator mapping are essential for adequate surgical preparation. The flap is based on septocutaneous perforators of the lateral circumflex femoral artery, located in the posterior septum between the tensor fascia latae and the gluteus medius muscle. Being relatively stiff, septocutaneous perforators are sensitive to kinking and compression, which is important to keep in mind during flap inset. A donor nerve can be taken and coapted with the flap for sensate autologous breast reconstruction. For larger breast volumes, bipedicled, conjoined, or stacked flaps are viable options. Quilting sutures during donor site closure is crucial in risk reduction of seroma formation and wound dehiscence. Complication risks seem comparable to other free flap breast reconstructions, such as the DIEP flap, especially when applying the quilting sutures at the donor site. During postoperative control visits at the outpatient clinic, additional procedures will be discussed, which often consist of lipofilling in the pectoralis major muscle for increasing upper pole volume, liposuction of the non-operated lateral thigh for symmetry in unilateral cases, or dog-ear corrections at the donor site.