Beyond the DIEP Flap: Thigh-Based Autologous Breast Reconstruction

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Define the indications, benefits, and drawbacks of thigh-based flap donor sites for breast reconstruction. 2. Recognize the differences between popular thigh-based flaps and the utility of each. 3. Understand the anatomy of thigh-based free flaps, including their landmarks, vascular pedicles, and techniques of flap harvest. 4. Manage donor-site healing and complications. SUMMARY: Thigh-based free flaps have become a popular flap option for autologous breast reconstruction. Critiques of thigh-based flaps include inadequate flap volume and donor-site concerns, such as poor appearance, sensory changes, and problematic healing; however, refinements in surgical technique have led to more predictable outcomes. The purpose of this article is to review the advantages and disadvantages of the various thigh-based free flaps for breast reconstruction, including gracilis myocutaneous, profunda artery perforator, and lateral thigh perforator flaps. Practical pearls for flap harvest and optimization of aesthetic results are provided.