scholarly journals The Versatility of Lateral Chest Wall Perforator Flaps in Immediate and Delayed Breast Reconstruction: Retrospective Study of Clinical Experience with 26 Patients

2021 ◽  
pp. 229255032110511
Author(s):  
Helene Retrouvey ◽  
Mary-Helen Mahoney ◽  
Brian Pinchuk ◽  
Waqqas Jalil ◽  
Ron Somogyi
Keyword(s):  
Breast Reconstruction ◽  
Chest Wall ◽  
Donor Site ◽  
Positive Margin ◽  
Outpatient Setting ◽  
Immediate Reconstruction ◽  
Patient Demographics ◽  
Effective Option ◽  
Delayed Breast Reconstruction ◽  
Lateral Chest

Rationale: Lateral chest flaps represent versatile reconstructive options, especially valuable in times of global healthcare resource restriction. In this series, we present our experience with the use of lateral chest wall flaps in both immediate and delayed reconstruction from both breast conserving and mastectomy surgery. Methods: A retrospective cohort study of patients who had undergone a lateral chest wall flap for immediate or delayed breast reconstruction of a lumpectomy or mastectomy defect was performed. Data collected consisted of patient demographics, procedure type, tumor/oncological characteristics, as well as postoperative complications. Findings: Between September 2015 and April 2021, 26 patients underwent breast reconstruction using a lateral chest wall flap. Fifteen patients (58%) underwent immediate reconstruction (9 lumpectomy; 6 mastectomy) and 11 (42%) underwent delayed breast reconstruction. All flaps survived, though 1 patient required partial flap debridement following venous compromise hours after surgery. There were no incidences of hematoma, seroma, infection, or wound healing delay at either the donor site or breast. There was one positive margin which occurred in a mastectomy patient. Significance: This study describes the use of lateral chest wall flaps in a wide variety of reconstructive breast surgery scenarios. This technique can be safely performed in an outpatient setting and does not require microvascular techniques. Review of our outcomes and complications demonstrate that this is a safe and effective option. Our experience is that this is an easy to learn, versatile flap that could be a valuable addition to the surgeon's arsenal in breast reconstruction.

scholarly journals Bilateral Breast Reconstruction With Profunda Artery Perforator Flaps and Immediate Implant Augmentation

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Carrie K Chu ◽  
Michael DeFazio ◽  
Rene D Largo ◽  
Merrick Ross
Keyword(s):  
Breast Reconstruction ◽  
Brca2 Mutation ◽  
Donor Site ◽  
Free Flaps ◽  
Fat Grafting ◽  
Silicone Implants ◽  
Level Of Evidence ◽  
Immediate Reconstruction ◽  
Immediate Implant ◽  
Artery Perforator

Abstract The smaller volume of the profunda artery perforator (PAP) flap relative to that of abdominal flaps limits the size of breast reconstruction that may be achieved. Immediate implant augmentation of abdominal free flaps has been performed, but immediate implant augmentation of PAP flaps has never been described. A 54-year-old woman with BRCA2 mutation, submuscular implants, and previous abdominoplasty presented for nipple-sparing mastectomies (NSM). Autologous tissue volume was inadequate to support reconstruction to the desired size. She wished to avoid serial expansion. Skin quality was unsuitable for direct-to-implant reconstruction. The patient underwent bilateral NSM. The previous implants were removed with capsule preservation. Bilateral PAP flaps were harvested and anastomosed to the internal mammary vessels. Moderate classic profile 170-mL smooth round silicone implants were placed into the existing capsule pockets with lateral capsulorraphy. There were no flap, implant, or infectious complications. Initial mastectomy skin and nipple ischemia completely resolved without necrosis. Donor site healing was uneventful. At 8 months, the reconstruction is supple and the implants remain well-positioned without rippling. One minor revision was performed for fat grafting and to correct lateral nipple deviation. PAP flap breast reconstruction with immediate implant augmentation is technically feasible. Advantages include improved prosthetic coverage, allowing for immediate reconstruction to a larger size with reduced concern regarding mastectomy skin necrosis and threat to the device, optimal implant camouflage, and improved substrate for secondary fat grafting if necessary. Level of Evidence: 5

Optimizing Outcomes in Free Flap Breast Reconstruction in the Community Hospital Setting: A Stepwise Approach to DIEP/SIEA Flap Procedures with Banking a Hemiabdominal Flap

2017 ◽  
Vol 33 (07) ◽  
pp. 474-482
Author(s):  
Alberto Okada ◽  
Diego Pereira ◽  
Eduardo Montag ◽  
Marcelo Portocarrero ◽  
Carlos Felício ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Donor Site ◽  
Hospital Setting ◽  
Smoking History ◽  
Early Complications ◽  
Community Hospitals ◽  
Immediate Reconstruction ◽  
Conventional Procedure ◽  
Siea Flap

Background Free flap breast reconstruction is a conventional procedure in many countries; however, microvascular compromise remains a devastating outcome. Given the morbidity of total necrosis, optimizing free flap salvage stands out as an important area for research, especially among surgeons to overcome the learning curve period and in resource constrained scenario such as community hospitals. To ensure free deep inferior epigastric perforator (DIEP)/superficial inferior epigastric artery (SIEA) flap breast reconstruction, the authors present a technique involving raising a hemiabdominal flap as a free flap, and banking the remaining flap to be utilized if needed in a subsequent procedure. Methods A retrospective review was performed on all free flap breast reconstructions. In this period, 84 patients (mean age: 50.1 ± 8 years) were included. Results In this study, 65.5% patients underwent immediate reconstruction, and 51.2% received DIEP reconstruction; 9.52% patients were returned to the operating room, and salvage reconstruction using the banked flap was performed in all patients. No differences were observed regarding early complications and age, body mass index, American Society of Anesthesiologists status, diabetes, smoking history, chemotherapy, radiotherapy, and type of flap used (p > 0.05). Hypertension was significantly associated with early complications (p < 0.05). Donor-site complications were associated with RT (p < 0.05). Conclusion The banked flap is a reliable method for ensuring DIEP/SIEA flap survival and should be considered in higher risk reconstructions and community hospitals. We believe that the present technique can be a good addition to the arsenal of plastic surgeons dealing with free flap breast reconstructions in selected patients.

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.

scholarly journals Psychosocial Aspects of Immediate versus Delayed Breast Reconstruction

Breast Care ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 374-377 ◽  
Author(s):  
Anne-Sophie Heimes ◽  
Kathrin Stewen ◽  
Annette Hasenburg
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Well Being ◽  
Psychological Outcomes ◽  
Psychosocial Aspects ◽  
Breast Cancer Patients ◽  
Immediate Reconstruction ◽  
Delayed Breast Reconstruction ◽  
Delayed Reconstruction

Background: Only little is known about the psychosocial aspects of breast cancer patients after mastectomy with immediate versus delayed breast reconstruction. Methods: We systematically screened PubMed using the following key words: mastectomy, immediate vs. delayed reconstruction, psychosocial aspects and quality of life. To highlight different psychological outcomes, studies were categorized into those describing: anxiety, depression, body image and satisfaction with the surgical outcome. We also compared patients after mastectomy alone with those undergoing immediate or delayed reconstruction. Results: Methodologies and psychological outcomes varied among the identified studies, making it difficult to compare results. There are contradictory outcomes concerning the psychosocial aspects of breast cancer patients after mastectomy alone compared with those who underwent an immediate or delayed reconstruction following mastectomy. Some studies show that immediate reconstruction after mastectomy had a positive impact on patients' psychological well-being. In contrast, other studies indicated that in the long-term view the compared patient groups were very similar concerning psychosocial aspects. Conclusion: Analyzing different aspects of psychosocial well-being after breast cancer surgery, there might be an advantage in choosing immediate reconstruction, if oncological safety allows it.

The impact of partial breast reconstruction with lateral chest wall perforator flaps on post-operative cancer surveillance

2018 ◽  
Vol 2 ◽  
pp. 10-10
Author(s):  
Jesse Hu ◽  
Alexandra Tenovici ◽  
Vaishali Parulekar ◽  
Madhu Bhattacharyya ◽  
Pankaj G. Roy
Keyword(s):  
Breast Reconstruction ◽  
Chest Wall ◽  
Cancer Surveillance ◽  
Perforator Flaps ◽  
Lateral Chest ◽  
The Impact

Breast Reconstruction with the TRAM Flap

2019 ◽  
pp. 695-700
Author(s):  
Windy A. Olaya
Keyword(s):  
Breast Reconstruction ◽  
Surgical Procedure ◽  
Donor Site ◽  
Breast Size ◽  
Tram Flap ◽  
Immediate Reconstruction ◽  
Pedicle Flap ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Tissue Volume ◽  
Tissue Reconstruction

Breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap offers a completely autogenous tissue reconstruction for women requesting either a delayed or immediate breast restoration. The donor site scar on the lower abdomen is hidden by most clothing styles. The flap can be harvested as a pedicle flap based on the superior epigastric vessels, including one or both rectus muscles, depending on the volume of tissue required. During immediate reconstruction, both the oncologic and reconstructive surgeons can operate simultaneously, continuously communicating during the surgical procedure about the incisions and mastectomy defect. The match between the tissue volume of the patient’s abdominal TRAM flap and her desired breast size determines the eventual aesthetic success of the reconstruction.

scholarly journals Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

2021 ◽  
Vol 10 (16) ◽  
pp. 3629
Author(s):  
Laurenz Weitgasser ◽  
Maximilian Mahrhofer ◽  
Karl Schwaiger ◽  
Kathrin Bachleitner ◽  
Elisabeth Russe ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Free Flaps ◽  
Lessons Learned ◽  
Diep Flap ◽  
Patient Demographics ◽  
Pedicle Length ◽  
History Of ◽  
Deep Inferior Epigastric Perforator ◽  
Low Bmi

Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. Patients and Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.

scholarly journals Lateral chest wall perforator flaps in partial breast reconstruction

2022 ◽  
Vol 34 (1) ◽  
Author(s):  
Ahmed Orabi ◽  
Mina M G Youssef ◽  
Tamer M. Manie ◽  
Mohamed Shaalan ◽  
Tarek Hashem
Keyword(s):  
Breast Reconstruction ◽  
Chest Wall ◽  
Operative Time ◽  
Standard Procedure ◽  
Cosmetic Outcome ◽  
Partial Mastectomy ◽  
Perforator Flaps ◽  
Oncoplastic Breast Surgery ◽  
Lateral Chest ◽  
Artery Perforator

Abstract Background Breast conserving surgery (BCS) has been a standard procedure for the treatment of breast cancer instead of mastectomy whenever possible. Lateral chest wall perforator flaps are one of the volume replacement techniques that participate in increasing the rate of BCS especially in small- to moderate-sized breasts with good cosmetic outcome. In this study, we tried to evaluate the outcome of those flaps as an oncoplastic procedure instead of the conventional flaps. Methods This study included 26 patients who underwent partial mastectomy with immediate reconstruction using lateral chest wall perforator flaps in the period from October 2019 to November 2020. The operative time, techniques, and complications were recorded. The cosmetic outcome was assessed 3 months post-radiation therapy through a questionnaire and photographic assessment. Results Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP) and combined flaps were performed in 24, 1, and 1 patients, respectively. The mean operative time was 129.6 ± 13.2 min. The flap length ranged from 10 to 20 cm and its width from 5 to 9 cm. Overall patients’ satisfaction was observed to be 88.5% as either excellent or good and the photographic assessment was 96.2% as either excellent or good. Conclusions Lateral chest wall perforator flaps are reliable and safe option for partial breast reconstruction with an acceptable aesthetic outcome. In the era of oncoplastic breast surgery, they deserve to gain attention especially with the advantages of some modifications added to the classic technique.

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