Lymphatic Drainage of the Deep Inferior Epigastric Artery Perforator Flap after Breast Reconstruction

Background: Transplanted tissue in breast reconstruction is routinely performed without any lymphatic anastomosis. Edemas might be observed at the level of these transplanted tissues. New lymphatic routes are supposed to develop but little is known about the development of new lymphatic vessels in the transplanted tissue after free flap transfer. The aim of the study was to evaluate the lymphatic drainage of the skin flap in patients after breast reconstruction. Material and Methods: In a series of 17 breast cancer patients, lymphatic drainage of DIEAP flaps was studied with lymphoscintigraphy. Three groups were differentiated in our series: 6 primary breast reconstructions (in the same operating time as the mastectomy), 9 secondary (in a different operating time as the mastectomy) and 2 for relapsing breast cancer. Results: After injection in the “areola” we noticed ipsilateral axillary and parasternal lymphatic drainage in five patients in the group of 6 while after injection was performed in the median part of the “large” skin flap we noticed ipsilateral axillary and parasternal lymphatic drainage in 7 patients and contralateral axillary and parasternal lymphatic drainage in 5 patients in the group of 9. In the group of 2 patients after injection in the “areola” we noticed only ipsilateral parasternal lymphatic drainage. Conclusions: Our results suggest a decrease in the deep lymphatic drainage of the skin flap (toward the ipsi and contralateral parasternal lymph nodes) in patients after reconstruction with deep flap. These results might have implications in the management of patients especially if edema is observed at the level of the transplanted skin.