The vertical gracilis myocutaneous flap for breast reconstruction in a massive weight loss patient

2021 ◽  
Vol 14 (12) ◽  
pp. e247182
Author(s):  
Martin Söderman ◽  
Jørn Bo Thomsen ◽  
Jens Ahm Sørensen
Keyword(s):  
Weight Loss ◽  
Breast Reconstruction ◽  
Free Flaps ◽  
Left Breast ◽  
Massive Weight Loss ◽  
Number Of Patients ◽  
Different Types ◽  
Perforator Vessels ◽  
Gracilis Myocutaneous Flap

The number of patients undergoing bariatric surgery is increasing worldwide. Different types of free flaps are often used for breast reconstruction following mastectomy. We present a not previously described case using a vertical myocutaneous gracilis flap for breast reconstruction in a massive weight loss patient. The patient was a 61 year-old woman who previously had a lumpectomy for an in situ ductile carcinoma of her left breast. Subsequently the patient underwent a full mastectomy in 2020 due to a recurrence. The massive weight loss population poses a challenge in reconstructive surgery, due to their higher risk of complications. However, we still believe free flaps should be considered as a valid option for breast reconstruction in these patients. Due to the often increased size of perforator vessels in these patients, other flaps may prove more suitable than the usually preferred ones.

scholarly journals Body contouring surgery in a massive weight loss patient: An overview

2008 ◽  
Vol 41 (S 01) ◽  
pp. 114-129 ◽  
Author(s):  
Prabhat Shrivastava ◽  
Aggarwal Aditya ◽  
Khazanchi Rakesh Kumar
Keyword(s):  
Weight Loss ◽  
Positive Impact ◽  
Body Contouring ◽  
Massive Weight Loss ◽  
The Body ◽  
Successful Outcome ◽  
Exciting Field ◽  
Body Contouring Surgery ◽  
Number Of Patients ◽  
The Individual

ABSTRACTThe number of patients with history of extreme overweight and massive weight loss (MWL) has risen significantly. Majority of patients are left with loose, ptotic skin envelopes, and oddly shaped protuberances, subsequent to weight loss. Redundant skin and fat can be seen anywhere on the body following MWL. This group of population presents many unique problems and challenges. Body contouring surgery after MWL is a new and exciting field in plastic surgery that is still evolving. Conventional approaches do not adequately cater to the needs of these patients. Complete history, detailed physical examination, clinical photographs and lab investigations help to plan the most appropriate procedure for the individual patient. Proper counseling and comprehensive informed consent for each procedure are mandatory. The meticulous and precise markings based on the procedure selected are the cornerstones to achieve the successful outcome. Lower body contouring should be performed first followed six months later by breast, lateral chest and arm procedures. Thighplasty is usually undertaken at the end. Body contouring operations are staged at few months′ intervals and often result in long scars. Staging is important as each procedure can have positive impact on adjacent areas of the body. Secondary procedures are often required. However, proper planning should lead to fewer complications and improved aesthetic outcome and patient satisfaction.

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lauren Sinik ◽  
Katie G. Egan ◽  
Krishna Patel ◽  
Niaman Nazir ◽  
James A. Butterworth
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Breast Reconstruction ◽  
Massive Weight Loss

Superficial Inferior Epigastric Vessels in the Massive Weight Loss Population: Implications for Breast Reconstruction

2008 ◽  
Vol 122 (6) ◽  
pp. 1621-1626 ◽  
Author(s):  
Jeffrey A. Gusenoff ◽  
Devin Coon ◽  
Carolyn De La Cruz ◽  
J Peter Rubin
Keyword(s):  
Weight Loss ◽  
Breast Reconstruction ◽  
Massive Weight Loss

Outcomes of Breast Reconstruction After Mastectomy Using Deep Inferior Epigastric Perforator Flap After Massive Weight Loss

2016 ◽  
Vol 76 ◽  
pp. S286-S289 ◽  
Author(s):  
Deniz Dayicioglu ◽  
Bugra Tugertimur ◽  
Kyra Munzenmaier ◽  
Maryam Khan ◽  
Paul Smith ◽  
...  
Keyword(s):  
Weight Loss ◽  
Breast Reconstruction ◽  
Perforator Flap ◽  
Massive Weight Loss ◽  
Deep Inferior Epigastric Perforator

scholarly journals Vertical Abdominoplasty Technique and the Impact of Preoperative Comorbidities on Outcomes

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Haley Bunting ◽  
Karen B Lu ◽  
Zhiguo Shang ◽  
Jeffrey Kenkel
Keyword(s):  
Weight Loss ◽  
Complication Rate ◽  
Body Contouring ◽  
Massive Weight Loss ◽  
Major Complications ◽  
Small Series ◽  
Proper Patient Selection ◽  
Number Of Patients ◽  
History Of ◽  
The Impact

Abstract Background As the number of patients requiring bariatric surgery has increased, so has the demand for body contouring after massive weight loss. Surgery involving the abdomen in these patients is particularly challenging as both vertical and horizontal laxity if often present, making traditional abdominoplasty techniques less effective. Objectives The aim of this study was to review the operative technique and evaluate the preoperative comorbidities and operative decisions that may impact patient outcomes in those undergoing vertical abdominoplasty. Methods A review of the authors’ technique is described. A retrospective chart review of patients who underwent vertical abdominoplasty for significant vertical and horizontal laxity after massive weight loss by a single surgeon between June 2007 and July 2019 was performed. Preoperative parameters, operative factors, and minor and major complications were evaluated. Results Our complication rate was 81% (13/16), which were all minor. No major complications were encountered. Patients with a history of nicotine use had a 100% complication rate. There was a trend toward higher seroma formation in patients with coronary artery disease and those with a history of smoking. There was also a trend toward higher wound dehiscence in patients with renal disease. The authors found no statistically significant correlation between complications and older age, higher weight of tissue resected, higher body mass index, and medical comorbidities. Conclusions This small series helps to elucidate the role of vertical abdominoplasty in the care of patients following massive weight loss and its associated morbidity. Proper patient selection, appropriate preoperative patient counseling, and sound surgical technique help to mitigate the negative outcomes. Level of Evidence: 4

scholarly journals Stacked Deep Inferior Epigastric Perforator Free Flaps with Immediate Implant Placement for Unilateral Breast Reconstruction

2017 ◽  
Vol 02 (01) ◽  
pp. e72-e74
Author(s):  
Keith Hood ◽  
Nishant Kumar ◽  
Stephane Braun ◽  
Kent Higdon
Keyword(s):  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Free Flaps ◽  
Left Breast ◽  
Diep Flap ◽  
Augmentation Mammoplasty ◽  
Aesthetic Result ◽  
Implant Placement ◽  
Deep Inferior Epigastric Perforator ◽  
Immediate Implant

Background Autologous flaps can be used in combination with prosthesis in postmastectomy breast reconstruction. The deep inferior epigastric perforator (DIEP) flap is considered the preferred choice among autologous tissue transfer techniques. In patients with a breast volume asymmetry, there are several options for attaining an optimal reconstructive and aesthetic result. Methods This report presents a patient who underwent a combination of reconstructive techniques to achieve volumetric symmetry. Results The patient had a previous bilateral augmentation mammoplasty, was then treated for left breast carcinoma with a lumpectomy and radiation, and since that time had a recalcitrant left capsular contracture despite multiple operative interventions. The patient ultimately chose to have autologous left breast reconstruction and a stacked DIEP flap with simultaneous implant placement was performed. Conclusion In cases of significant volumetric asymmetry, a stacked DIEP flap in combination with a prosthesis is a novel and safe solution.

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