Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity

1999 ◽  
Vol 52 (5) ◽  
pp. 351-354 ◽  
Author(s):  
Z.M. Arnez ◽  
U. Khan ◽  
D. Pogorelec ◽  
F. Planinsek
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Rational Selection ◽  
Selection Of

scholarly journals Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique

2020 ◽  
Vol 9 (9) ◽  
pp. 3030
Author(s):  
Kathrin Bachleitner ◽  
Laurenz Weitgasser ◽  
Amro Amr ◽  
Thomas Schoeller
Keyword(s):  
Breast Cancer ◽  
Surgical Technique ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Operating Time ◽  
Cancer Recurrence ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Aesthetic Result ◽  
Secondary Operations

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein.

Comprehensive Analysis of Donor-Site Morbidity in Abdominally Based Free Flap Breast Reconstruction

2013 ◽  
Vol 132 (6) ◽  
pp. 1383-1391 ◽  
Author(s):  
Edward I. Chang ◽  
Eric I. Chang ◽  
Miguel A. Soto-Miranda ◽  
Hong Zhang ◽  
Naveed Nosrati ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Comprehensive Analysis

Alternative flaps for microsurgical breast reconstruction

2021 ◽  
pp. 1107-1114
Author(s):  
Hinne A. Rakhorst
Keyword(s):  
Breast Reconstruction ◽  
Standard Care ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
The Body ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Muscle Sparing ◽  
Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction

2014 ◽  
Vol 103 (4) ◽  
pp. 249-255 ◽  
Author(s):  
H. C. Benditte-Klepetko ◽  
F. Lutgendorff ◽  
T. Kästenbauer ◽  
M. Deutinger ◽  
C. M. A. M. van der Horst
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Deep Inferior Epigastric Perforator ◽  
Types Of Breast Reconstruction

Background and Aims: Breast reconstruction has been shown to improve quality of life. However, factors involved in long-term patient satisfaction are largely unknown. Our aim was to evaluate patient satisfaction and donor-site morbidity in five types of breast reconstruction. Material and Methods: A prospectively collected database of all breast surgery patients at Hospital Rudolfstiftung, Vienna, Austria, was searched for five types of breast reconstruction (2000–2006): implant, latissimus dorsi-flap, latissimus dorsi-flap with implant, free transverse rectus abdominis musculocutaneous-flap, and deep inferior epigastric perforator-flap. Patients were sent a study-specific questionnaire to assess satisfaction. Short-form 36-item health survey was used to analyze (quality of life), and complication data were retrieved from the database and assessed during a follow-up visit. Results: There were 257 patients identified, of whom, 126 responded to the survey (17 implant, 5 latissimus dorsi + implant, 64 latissimus dorsi, 22 transverse rectus abdominis musculocutaneous, and 18 deep inferior epigastric perforator reconstructions). No statistical differences were found in complication or reoperation rates. Deep inferior epigastric perforator–flap patients were significantly more satisfied compared to patients from the implant group ( p = 0.007). However, there was no significant difference regarding quality of life scores among the groups. After logistic regression analysis, only “impairment on daily life” showed to be independently correlated with patient satisfaction. This contrary to both operation type and complication rate which did not correlate with patient satisfaction. Conclusions: Our results indicate that operation type, complication rate, and revision rate did not independently correlate with patient satisfaction. Therefore, to further improve patient satisfaction, future research should be focused on other pro-operative factors, for example, patient education, expectations, and personality characteristics.

scholarly journals Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Hani Shash ◽  
Becher Al-halabi ◽  
Salah Aldekhayel ◽  
Tassos Dionisopoulos
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Patient Characteristics ◽  
Donor Site Morbidity ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Search Terms ◽  
The Mean ◽  
Pedicle Flaps

Background: Evidence on the use of omental flaps for breast reconstruction in patients with breast cancer is lacking, and no published reviews report an outcome-based assessment of such flap. This review explores available data and evidence for change in complication rates following the shift toward laparoscopic harvesting. Methods: We searched the databases Excerpta Medica database, MEDLINE, and PubMed from inception until December 2015 using search terms “omental flaps“ and “breast reconstruction.” Data extracted were patient characteristics, technique used, and outcome measures reported and were then analyzed based on the technique of harvesting. Results: Twenty-two articles reporting 651 patients who underwent mastectomies and breast-conserving surgeries were included in this review. Most flaps, 537 (82.5%), were harvested by laparoscopy, and 626 (96.2%) of the flaps were pedicle flaps. The mean age was 47.7 years (standard deviation: 4.29), and mean follow-up was 38.1 months. There were 88 reported complications among 562 patients in 16 reports. The rate of any complication was calculated to be 15.0%, with a higher rate (29.1%) occurring with the open technique in comparison to laparoscopy (12.6%). The commonest complications were postoperative infection and breast firmness each reported in 2.22%. Most authors reported advantages of malleability and excellent aesthetic outcomes and disadvantages in terms of inability to estimate the volume of the flap and variability in size. Conclusion: Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.

scholarly journals Assessment of the abdominal wall function after pedicled TRAM flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect

2010 ◽  
Vol 43 (02) ◽  
pp. 166-172
Author(s):  
Chacko Cyriac ◽  
Ramesh Kumar Sharma ◽  
Gurpreet Singh
Keyword(s):  
Breast Reconstruction ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Donor Site ◽  
Rectus Sheath ◽  
Donor Site Morbidity ◽  
Tram Flap ◽  
Wall Function ◽  
Abdominal Wall Function

ABSTRACT Background: The pedicled TRAM flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional TRAM flap. This has generally been cited as one of the main reasons for resorting to “abdominal wall friendly” techniques. This study has been undertaken to assess the abdominal wall function in patients with pedicled TRAM flap breast reconstruction. The entire width of the muscle and the overlying wide disk of anterior rectus sheath were harvested with the TRAM flap in all our patients and the anterior rectus sheath defect was repaired by a Proline mesh. Materials and Methods: Abdominal wall function was studied in 21 patients who underwent simultaneous primary unipedicled TRAM flap reconstruction after mastectomy for cancer. In all the patients, the abdominal wall defect was repaired using wide sheet of Proline mesh both as inlay and onlay. The assessment tools included straight and rotational curl ups and a subjective questionnaire. The abdominal wall was also examined for any asymmetry, bulge, or hernia. The minimal follow-up was 6 months postoperative. The objective results were compared with normal unoperated volunteers. Results and Conclusions: The harvesting the TRAM flap certainly results in changes to the anterior abdominal wall that can express themselves to a variable degree. A relatively high incidence of asymptomatic asymmetry of the abdomen was seen. There was total absence of hernia in our series even after a mean follow-up period of 15.5 months. A few patients were only able to partially initiate the sit up movement and suffered an important loss of strength. In most patients, synergists took over the functional movement but as the load increased, flexion and rotation performances decreased. The lack of correlation between exercise tests and the results of the questionnaire suggests that this statistically significant impairment was functionally not important. The patients encountered little or no difficulty in theis day-to-day activities. Our modification of use of a wide mesh as inlay and onlay repair minimizes the donor site morbidity. This also avoids maneuvers meant for primary closure of the rectus sheath defects, which can result in distortion of umbilicus. Therefore, in conclusion, the unipedicled TRAM flap should be regarded as a valuable option in breast reconstruction provided careful repair of the abdominal wall defect is undertaken using Proline mesh.

The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction

1997 ◽  
Vol 50 (5) ◽  
pp. 322-330 ◽  
Author(s):  
Ph.N. Blondeel ◽  
G.G. Vanderstraeten ◽  
S.J. Monstrey ◽  
K. Van Landuyt ◽  
P. Tonnard ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Donor Site Morbidity

Check the Record: Remote CT Scans for Breast Flap Perforator Mapping

2018 ◽  
Vol 34 (07) ◽  
pp. 485-491 ◽  
Author(s):  
Amanda Sergesketter ◽  
Bryan Pyfer ◽  
Brett Phillips ◽  
Ruya Zhao ◽  
Scott Hollenbeck
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Ct Scans ◽  
Autologous Reconstruction ◽  
Positron Emission ◽  
Pet Ct ◽  
Delayed Breast Reconstruction ◽  
Average Utility

Background Perforator mapping with computed tomography angiography (CTA) prior to autologous breast reconstruction reduces donor-site morbidity and operative time, but is costly. The aim of this study was to evaluate whether pre-existing CT scans could be used for dominant perforator identification before autologous reconstruction. Methods We identified all female patients who underwent mastectomy with immediate or delayed breast reconstruction with abdominal free flaps at a single institution between 2006 and 2016. Medical records were reviewed to identify patients with pre-existing CT scans of the abdomen/pelvis. CT images were reviewed by the senior surgeon and ranked on a 1 to 3 scale to indicate utility for preoperative planning. An analysis was performed to assess financial savings and radiation avoidance associated with the use of pre-existing scans. Results Of 301 identified patients, 44.9% (n = 135) had an available pre-existing CT. A dominant perforator was identified on 92.6% of scans. A higher proportion of dominant perforators was identified using positron emission tomography (PET)/CT scans compared with CT scans with intravenous (IV) contrast and noncontrast CTs (p < 0.0001). Compared with PET/CTs and CTs with IV contrast, the average utility score for noncontrast CTs was lower (p = 0.0001). Dominant perforators were clearly identified in patients who had both a remote CT scan and a preoperative CTA. Perforator mapping using remote CT scans yielded a projected radiation reduction of 13.2 mGy per patient and yielded a projected annual U.S. health care savings of $28,459,638. Conclusion Our study suggests that pre-existing CT scans represent a viable and economical alternative for perforator mapping before abdominal-based free flap breast reconstruction.

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