Objective. To reduce donor site morbidity and optimize the concept of perforator vessel choosing in delayed breast reconstruction with deep inferior epigastric artery perforator (DIEAP) flap.

Material and methods. We retrospectively analyzed abdominal perforator exchange (APEX) technique for delayed breast reconstruction with DIEAP flap in patients who underwent surgery between April 2020 and October 2024. All patients underwent preoperative magnetic resonance angiography of the donor area. Patients were divided into two groups: the study group included patients who underwent breast reconstruction using the abdominal perforator exchange (APEX) technique, while the control group consisted of patients who underwent reconstruction with the standard DIEP flap approach. Statistical analysis was performed using the program StatTech v. 4.7.2 (StatTech LLC, Russia).

Results. Three different types of perforator bifurcation were identified among patients in the APEX group, with bifurcation type “A” being the most common. The mean operative time and pedicle dissection time were significantly longer in the APEX group. A statistically significant difference in fascial incision length was also observed. Satisfaction with functional status of anterior abdominal wall was higher in the APEX group. There were no significant differences in satisfaction with donor site appearance.

Keywords. breast reconstruction, DIEAP flap, perforator flaps, perforator vessel selection, donor site morbidity, abdominal perforator exchange (APEX)