scholarly journals How Do We Raise the Bar in Autologous Breast Reconstruction? The Use of Progressive Tension Sutures for Donor Site Closure

2019 ◽  
Vol 7 ◽  
pp. 22-23
Author(s):  
Kristy L. Hamilton ◽  
Andres F. Doval ◽  
Kieran S. Boochoon ◽  
Aldona J. Spiegel
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Autologous Breast Reconstruction ◽  
Progressive Tension Sutures

scholarly journals Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989883
Author(s):  
Trina V. Stephens ◽  
Nancy Van Laeken ◽  
Sheina A. Macadam
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
First Line ◽  
Percutaneous Aspiration ◽  
Autologous Breast Reconstruction ◽  
History Of ◽  
Deep Inferior Epigastric Perforator ◽  
Latissimus Dorsi Flaps

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.

How Does Autologous Breast Reconstruction Impact Downtime?

2018 ◽  
Vol 34 (07) ◽  
pp. 530-536 ◽  
Author(s):  
Daniel Rais ◽  
Jian Farhadi ◽  
Giovanni Zoccali
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Superior Gluteal Artery ◽  
Free Flap Surgery ◽  
Recovery Times ◽  
Time Required ◽  
The Impact

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

Breast Reconstruction with Non-Abdominal–Based Free Tissue Flaps

2019 ◽  
pp. 795-802
Author(s):  
Erica Bartlett ◽  
Aldona J. Spiegel
Keyword(s):  
Surgical Technique ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Autologous Breast Reconstruction ◽  
Superior Gluteal Artery ◽  
Alternative Donor ◽  
Lateral Thigh ◽  
Tissue Flaps ◽  
Artery Perforator

Abdominal-based free tissue transfer accounts for the majority of autologous breast reconstruction. In situations where abdominal sources are unavailable, other donor sites should be considered. In this chapter, alternative donor sites for autologous breast reconstruction are discussed, specifically, gluteal- and thigh-based flaps. The superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps are discussed from the gluteal donor site, and the transverse upper gracilis (TUG), profunda artery perforator (PAP), and the lateral thigh perforator (LTP) flaps are discussed from the thigh donor site. Relevant anatomy and surgical technique are discussed for each flap in order to enhance awareness of secondary flap options in the plastic surgeon’s armamentarium for breast reconstruction.

Unilateral Autologous Breast Reconstruction with Bi-pedicled, Conjoined Deep Inferior Epigastric Perforator Flaps

2018 ◽  
Vol 35 (02) ◽  
pp. 145-155 ◽  
Author(s):  
Akhil Seth ◽  
Pieter Koolen ◽  
Steven Sultan ◽  
Bernard Lee ◽  
Heather Erhard ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Side Branch ◽  
Diep Flap ◽  
Autologous Breast Reconstruction ◽  
Pedicled Flaps ◽  
Skin Envelope ◽  
The Status ◽  
Deep Inferior Epigastric Perforator

Background The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and “footprint.” This study summarizes our experience with using bipedicled DIEP flaps to improve the aesthetic results of unilateral breast reconstruction in such patients. Methods Consecutive patients undergoing unilateral breast reconstruction with bi-pedicled, conjoined DIEP flaps over a 4-year period were retrospectively reviewed. Primary and secondary flap microvascular anastomoses were performed to the antegrade internal mammary (IM) vessels and to either the retrograde IM vessels or a primary DIEP pedicle side branch, respectively. Clinical characteristics and outcomes were recorded. Results Sixty-three patients underwent immediate (n = 29) or delayed (n = 34) reconstruction, with age and body mass index of 54.1 ± 8.4 years and 26.6 ± 4.7, respectively. Mean follow-up was 14.1 months. Twenty-eight (44.4%) patients received prereconstruction radiation therapy. All patients had preoperative abdominal imaging, including 57 (90.5%) using magnetic resonance angiography. There were no flap losses with three operative interventions for flap salvage. Conclusion Unilateral breast reconstruction with bipedicled, conjoined DIEP flaps is safe and reliable. These procedures can be performed with a complication profile similar to single-pedicle DIEP flaps. The additional skin and soft tissue available with bi-pedicled flaps allows for greater flexibility in matching the shape and projection of a woman's contralateral breast, and in some cases is necessary to achieve an aesthetically acceptable reconstruction. With growing expectations among breast reconstruction patients, conjoined bi-pedicled flaps represent a tool for meeting their reconstructive needs and exceeding the status quo for aesthetic outcomes.

Aesthetic Refinement of the Abdominal Donor Site after Autologous Breast Reconstruction

2015 ◽  
Vol 136 (3) ◽  
pp. 455-461 ◽  
Author(s):  
Mark W. Stalder ◽  
Katherine Accardo ◽  
Robert J. Allen ◽  
Alireza Sadeghi
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Autologous Breast Reconstruction

scholarly journals The Fleur-de-PAP Flap for Bilateral Breast Reconstruction

2016 ◽  
Vol 02 (01) ◽  
pp. e1-e3 ◽  
Author(s):  
Katharine Saussy ◽  
Mark Stalder ◽  
Stephen Delatte ◽  
Robert Allen ◽  
Hugo St Hilaire
Keyword(s):  
Breast Reconstruction ◽  
Female Patient ◽  
Donor Site ◽  
Perforator Flap ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Posterior Thigh ◽  
Single Donor ◽  
Ptotic Breasts ◽  
Artery Perforator

AbstractThe authors present the case of a 42-year-old female patient who underwent autologous breast reconstruction using a new perforator flap designed from the medial and posterior thigh. Due to a prior abdominoplasty, the patient's abdominal donor site was unavailable to reconstruct her large, ptotic breasts, so an alternate approach was undertaken. The fleur-de-PAP flap is based on the same perforators employed by the standard profunda artery perforator (PAP) flap, but simultaneously incorporates tissue from both the transverse and vertical PAP flap skin paddles. This design maximizes flap volume at a single donor site and provides a reasonable secondary option for autologous reconstruction in large-breasted patients in whom the abdomen is not available.

scholarly journals The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

Breast Cancer ◽  
2021 ◽  
Author(s):  
Laura C. Siegwart ◽  
Sebastian Fischer ◽  
Yannick F. Diehm ◽  
Jörg M. Heil ◽  
Christoph Hirche ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Normal Weight ◽  
Autologous Breast Reconstruction ◽  
Medial Thigh ◽  
The Mean ◽  
Breast Shape ◽  
Surgical Site Complications

Abstract Purpose The transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction. Methods A retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts. Results Ninety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs. Conclusion The TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

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