Aesthetic Plastic Surgery

, Volume 41, Issue 4, pp 768–772 | Cite as

The Reconstruction Choice for Giant Phyllodes Tumor of Breast: Bi-pedicled Deep Inferior Epigastric Perforator Flap

  • Chien-Liang FangEmail author
  • Chin-Hao Hsu
  • Chin-Wen Tu
Original Article Breast Surgery



Phyllodes tumors of the breast are the rarest of all breast neoplasms. Giant phyllodes tumors (>10 cm) of the breast have been less discussed in the literature. Reconstruction of the large defect created after wide excision (safety margin >1 cm) is a challenge in these patients. We present one technique using a bi-pedicled deep inferior epigastric perforator flap for post-mastectomy breast reconstruction for giant phyllodes tumors.

Methods and Results

We treated three patients with giant phyllodes tumors between 2013 and 2016. The histological characteristics were benign and borderline; tumor sizes were 18 × 13 × 12, 20 × 16 × 9.5, and 18 × 15 × 9 cm. Immediate post-mastectomy reconstruction was performed using bi-pedicled deep inferior epigastric perforator flaps. Flap sizes measured 30 × 11, 28 × 12, and 28 × 13 cm. Total operative time, including that for mastectomy, was 285, 425, and 410 min. The duration of hospital stay was 12, 13, and 9 days. No local recurrence or distant metastasis occurred in the first two patients over a follow-up period of 3 years and in the third patient over a follow-up period of 6 months.


A higher local recurrence rate was associated with positive margins, histological grade, tumor size, and necrosis. Immediate post-mastectomy breast reconstruction may become the preferred option for treatment of giant phyllodes tumors. A bi-pedicled deep inferior epigastric perforator flap conferred adequate leverage for wide excision and resolved scar contracture of the axilla. Good functional and cosmetic results were achieved.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Giant Phyllodes Bi-pedicled DIEP 



I disclose any commercial interest that they may have in the subject of study and the source of any financial or material support.

Supplementary material

Supplementary material 1 (WMV 74009 kb)


  1. 1.
    Geisler DP, Boyle MJ, Malnar KF (2000) Phyllodes tumors of the breast: a review of 32 cases. Am Surg 66(4):360–366PubMedGoogle Scholar
  2. 2.
    Lenhard MS, Kahlert S, Himsl I (2008) Phyllodes tumour of the breast: clinical follow-up of 33 cases of this rare disease. Eur J Obstet Gynecol Reprod Biol 138(2):217–221CrossRefPubMedGoogle Scholar
  3. 3.
    Guillot E, Couturaud B, Reyal F (2011) Management of phyllodes breast tumors. Breast J 17(2):129–137CrossRefPubMedGoogle Scholar
  4. 4.
    Mangi AA, Smith BL, Gadd MA (1999) Surgical management of phyllodes tumors. Arch Surg 134(5):487–492CrossRefPubMedGoogle Scholar
  5. 5.
    Barrio AV, Clark BD, Goldberg JI (2007) Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol 14(10):2961–2970CrossRefPubMedGoogle Scholar
  6. 6.
    Chaney AW, Pollack A, McNeese MD (2000) Primary treatment of cystosarcoma phyllodes of the breast. Cancer 89(7):1502–1511CrossRefPubMedGoogle Scholar
  7. 7.
    Reinfuss M, Mituś J, Duda K (1996) The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer 77(5):910–916CrossRefPubMedGoogle Scholar
  8. 8.
    Ali RS, Garrido A, Ramakrishnan V (2002) Stacked free hemi-DIEP flaps: a method of autologous breast reconstruction in a patient with midline abdominal scarring. Br J Plast Surg 55(4):351–353CrossRefPubMedGoogle Scholar
  9. 9.
    Xu H, Dong J, Wang T (2009) Bipedicle deep inferior epigastric perforator flap for unilateral breast reconstruction: seven years’ experience. Plast Reconstr Surg 124(6):1797–1807CrossRefPubMedGoogle Scholar
  10. 10.
    Xiao M, Zhu O, Jiang Y (2015) Local recurrent phyllodes tumors of the breast: clinical and sonographic features. J Ultrasound Med 34(9):1631–1638CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2017

Authors and Affiliations

  1. 1.Division of Plastic and Reconstruction Surgery, Department of SurgeryDitmanson Medical Foundation Chia-Yi Christian HospitalChia-Yi CityTaiwan
  2. 2.Division of General Surgery, Department of SurgeryDitmanson Medical Foundation Chia-Yi Christian HospitalChia-Yi CityTaiwan

Personalised recommendations