Perforator flap breast reconstruction in thin patients.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 242-242
Author(s):  
C. M. Chen ◽  
C. Ahn ◽  
J. Levine
Keyword(s):  
Breast Reconstruction ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Perforator Flap ◽  
Preoperative Imaging ◽  
Perforator Flaps ◽  
Autologous Tissue ◽  
New Techniques ◽  
Medial Thigh ◽  
Abdominal Flaps

242 Background: Perforator flap breast reconstruction has strong appeal for many women seeking breast reconstruction, but the procedure requires adequate donor site tissue to produce realistic breasts. Thin women requesting perforator flaps are often advised that they lack sufficient donor site tissue for autologous tissue breast reconstruction, and that implants are their only option. We have expanded the reconstructive options for thin women who seek an alternative to implants with innovative new techniques. Methods: A retrospective review was done of 223 patients who underwent 293 consecutive perforator flap breast reconstructions from April 2007-May 2011. Preoperative imaging allowed visualization of the microvascular anatomy and subcutaneous tissue. Donor sites evaluated included the abdomen, medial thigh, buttocks, and back. Complications included flap loss, hematoma, seroma, takeback, and fat necrosis. No patients were turned away for perforator flap breast reconstruction due to insufficient donor site tissue. Results: Out of 293 perforator flap breast reconstructions, 45 perforator flap breast reconstructions (15.4%) were reported in 26 thin women with a BMI < 23 (mean BMI 20.7, range BMI 18.2-22.7). Out of 45 perforator flap breast reconstructions in thin women, donor sites included 35 hemi-abdominal flaps (77.8%), 4 medial thigh flaps (8.9%), 7 buttock flaps (15.6%), and 2 back flaps (4.4%). Of the 35 hemi-abdominal flaps, 8 hemi-abdominal flaps were combined to create 4 stacked DIEP flaps (22.9%) while the remaining 27 hemi-abdominal flaps were regular DIEP flaps (77.1%). There was one seroma (2.2%) and one takeback for postoperative pain (2.2%); there were no flap losses. Conclusions: Even in thin women, perforator flap breast reconstruction is a safe, reliable, and consistent technique for recreating new breasts. While implant-based breast reconstruction may be acceptable to many women, there is a growing subgroup of patients who prefer autologous tissue breast reconstruction. By challenging common conceptions about the amount of donor site tissue required, we have been able to expand reconstructive options in thin women by using perforator flaps to construct natural, aesthetic breasts.

scholarly journals Breast Reconstruction with Perforator Flaps in Poland Syndrome: Report of a Two-Stage Strategy and Literature Review

Breast Care ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 421-427
Author(s):  
Boyang Xu ◽  
Tong Liu ◽  
Chunjun Liu
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Pectoralis Major Muscle ◽  
Perforator Flap ◽  
Alternative Methods ◽  
Congenital Deformity ◽  
Poland Syndrome ◽  
Perforator Flaps ◽  
Proper Patient Selection

Background: Poland syndrome is a congenital deformity presenting unilateral hypoplasia of the breast, pectoralis muscle, and ipsilateral skeletal anomalies. In complex female cases, the significant amount of soft tissue needed for reconstruction continues to be a surgical challenge. Perforator flaps offer alternative methods with sufficient tissue volume, minimal donor site morbidity, and natural cosmetic outcome; however, their role in Poland syndrome breast reconstruction is seldom discussed. This study aims to present a new 2-stage strategy for esthetic restoration of the Poland syndrome chest anomaly that achieves breast symmetry while maintaining a scarless appearance. Case Presentation: A 38-year-old female presented with Poland syndrome on the right side, and amastia, athelia, and absence of pectoralis major muscle were observed. We present an innovative 2-stage approach consisting of tissue expansion and, successively, a deep inferior epigastric perforator flap transfer. A pleasing breast appearance had been achieved at 6 months of follow-up. A literature review regarding the use of free perforator flaps in Poland syndrome was conducted to demonstrate the applicability of this method. Seven articles described a total of 15 cases using free perforator flaps met the inclusion criteria and were summarized. A satisfactory correction was reported in all the cases. Conclusion: Perforator flaps provide reliable alternatives for Poland syndrome breast and chest-wall reconstruction. Proper patient selection and thorough assessment are vital to the success of the surgery.

Designing Anterolateral Thigh Flap Using Ultrasound

2021 ◽  
Author(s):  
Giuseppe Visconti ◽  
Alessandro Bianchi ◽  
Akitatsu Hayashi ◽  
Marzia Salgarello
Keyword(s):  
Subcutaneous Tissue ◽  
Preoperative Evaluation ◽  
Donor Site ◽  
Perforator Flap ◽  
The Body ◽  
Anterolateral Thigh Flap ◽  
Perforator Flaps ◽  
Anterolateral Thigh ◽  
Ultrasound Technology ◽  
The Given

Abstract Background Preoperative knowledge of themicrovascular anatomy of a patientmay improve safetyand efficacy and reduce morbidity. Today, with the advancement in technology, ultrasound can provide minute details of the structures within the body, which makes this technology very helpful in preoperative evaluation of the traditional perforator flaps as well as thin, superthin, and pure skin perforator flaps. Methods In this article, we will describe the design of one of the most popular perforator flaps, the anterolateral thigh (ALT) flap, using high-frequency and ultrahigh-frequency ultrasound technology. Results Ultrasound technology allows to study preoperatively the ALT donor-site and its microvascular anatomy by using different US modalities in order to provide a virtual surgical plan to the operating surgeon. Conclusion Ultrasound technology allow to expand preoperative knowledge of flap microvascular anatomy and its course within the subcutaneous tissue up to and within the dermis, allowing to select the best perforator for the given reconstruction and the plane of elevation for thin, superthin and pure skin perforator flap.

Breast Reconstruction After Resection of Bilateral Giant Phyllodes Tumors: Two Separate Deep Inferior Epigastric Perforator Flaps From One Donor Site

2020 ◽  
Vol 20 (2) ◽  
pp. e188-e191
Author(s):  
Chin-Wen Tu ◽  
Chien-Liang Fang ◽  
Chong-Bin Tsai ◽  
Chin-Hao Hsu ◽  
Chih-Hsuan Changchien ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Perforator Flaps ◽  
Phyllodes Tumors ◽  
Deep Inferior Epigastric Perforator

The Influence of Closing the Abdominal Donor-Site Superficial Fascial System in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

2021 ◽  
Vol 148 (3) ◽  
pp. 357e-364e
Author(s):  
Ariel C. Johnson ◽  
Becky B. T. King ◽  
Salih Colakoglu ◽  
Jerry H. Yang ◽  
Tae W. Chong ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Perforator Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Superficial Fascial System

Anterior Intercostal Artery Perforator Flap as a Simple Technique for Partial Breast Reconstruction: Our Institutional Initial Experience

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 40-40
Author(s):  
R Amira Maher ◽  
Ahmed Gamal Eldin Osman ◽  
K Fahmy ◽  
Nouf M. Ebied ◽  
Reda Eissa
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Perforator Flap ◽  
Cosmetic Outcome ◽  
University Hospital ◽  
Intercostal Artery ◽  
Breast Size ◽  
Cancer Management ◽  
The Mean ◽  
Artery Perforator

Background: The oncoplastic surgery has brought new dimensions to breast conserving surgery and added the aesthetic principles of breast surgery to breast cancer management. Recently there's a lot of volume replacement techniques without significant donor site morbidity .The anterior intercostal artery perforator (AICAP) flap is a suitable option in partial breast reconstruction for lower pole tumors in small and medium sized breasts. Objectives: The aim of this study is to report our clinical experience with anterior intercostal perforator flap in partial breast reconstruction Methodology: 25 cases were performed between April 2018 to June 2019 at in Ain shams university hospitals for selected patients with lower breast pole tumors with small and medium sized breast and other option like reduction mMDTmoplasty wasn't favorable for them. Results: A total of 25 patient were selected by the multidisplinary team at Ain shams university hospital for partial breast reconstruction with anterior intercostal artery perforator flap . The mean age of the cases was 45.68 with mean body mass index of 32.32. The mean operative time for the flap was 64 minutes while the hospital stay was ranging from 1-2 days .Follow-up for local recurrence was from 6 to 14 months. There was 1 case with wound complication (4%). The cosmetic outcome was assessed by the MDT and a giving score from 1-5 was used with 1 is the least favorable cosmetic outcome and 5 is the best result 76% of the cases scored 5, 14% scored 4, 8% scored 3. According to patient satisfaction a score from 1 to 5 was used with the score 1 is least satisfied and score 5 represents the most satisfaction level, there was 80% of the patient gave the score 5, 12% of the cases gave the score 4 and 8% of the cases gave the score 3 Conclusions: Based on our experience, partial breast reconstruction using AICAP flap is a reliable option for lower breast tumors in small-to-moderate breast size with perfect cosmetic outcome and negligible rate of complication.

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.

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