Summarizing the advantages of the intraflap versus cranial-caudal anastomoses in stacked free flap breast reconstruction.

Getting enough volume in autologous breast reconstruction can be difficult and transferring multiple free flaps to reconstruct a single breast can provide a solution to that problem. How to connect the free flaps pedicles to the recipient site has been a point of discussion in the literature and two main approaches have been described. The first one involves using the caudal stumps of the internal mammary (IM) vessels and is usually referred to “cranial-caudal” approach. The second one implies the anastomosis between one flap’s pedicle to a branch of the other one . This technique has been named in different ways in the literature: intraflap, flow-through, daisy-chain, chain-link and others. In the present letter we want to list what we think are all the advantages of the intraflap approach compared to the cranial-caudal one. To our knowledge, some of them have not been mentioned in the available literature.