Treatment of chest wall osteoradionecrosis with contralateral breast Y-V flap: case report

Introduction:Chest wall osteoradionecrosis(ORN) in breast cancer is one of the most serious complications of radiation therapy. Treatment requires wide debridement and coverage with a well-vascularized flap. However, the extensive radiation-induced injury, and a limit to performing wide resection of the injured bones are challaged to treatment. Herein, we present our experience with chest wall ORN treated with contralateral breast Y-V flap.Case presentationAn 81-year-old woman diagnosed with ORN of the chest wall had a severe ptotic breast. Reconstruction was planned to cover the open wound of the chest wall using redundant contralateral breast tissue. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast while preserving the perforators of the left lateral thoracic artery. The flap was spread in a Y-V advancement fashion to cover the open wound. The patient was discharged 2 weeks after surgery following suture removal. At 19 months post-operation, there were no complications or recurrences of ulcers. The patient was satisfied with the short recovery time and the surgical results.ConclusionThe contralateral breast Y-V flap allows simple and quick reconstruction, and having more options for chest wall reconstruction will allow for a more flexible treatment plan for each patient.

Single Staged Mastopexy With Autologous Fat Grafting: An Alternative to Augmentation Mastopexy With Implants

Background Improving the ptotic breast with mastopexy and restoring upper pole fullness with augmentation continues to be a challenging issue for plastic surgeons. Autologous fat grating (AFG) for shaping and contouring of implant augmented breasts has shown positive outcomes with few complications. Objectives The objective of this study was to evaluate our experience with combined mastopexy and fat grafting for women with existing breast ptosis who prefer not to receive prosthetic breast implants but do desire volume enhancement. Methods A retrospective review of patients undergoing a single staged mastopexy with AFG, from 2006 to 2017, was performed. Inclusion criteria were women with breast ptosis or tuberous breasts desiring improved breast shape and volume. Patients were excluded if they were undergoing implant removal before the procedure. Clinical aesthetic outcomes were assessed by fellow plastic surgeons according to the Telemark Breast Scoring system. Results A total of 284 breasts, in 140 women, underwent a single staged mastopexy with AFG. The mean amount of fat grafted per breast was 299.4 mL (range, 50-710 mL). There were no surgical site infections, hematomas, or seromas. There were 3 major and 8 minor (0.06%) postoperative breast complications. A total of 13 plastic surgeons, of the 183 invited (7.1%), completed the breast outcomes survey. Regarding each category, there was significant improvement (P ≤ 0.0001) in upper pole fullness, ptosis, overall aesthetics, and symmetry postoperatively. Conclusion AFG combined with mastopexy is not associated with significant postoperative complications and results in excellent breast aesthetic outcomes. Level of Evidence: 4

Evaluation of the Vertical Movement of Ribeiro’s Dermolipoglandular Mammary Flap One Year After Mammaplasties in Post-Bariatric Patients

Background In 1971, Ribeiro isolated a segment in the inferior pole of the ptotic breast, nourished by muscular perforating vessels, and moved it cranially to the posterior region of the remaining detached breast tissue, where it was fixed to the pectoral fascia. This maneuver created a flap with autologous implant function, independent from the rest of the breast’s support, that maintained long-term mammary projection. Objectives The objectives of this study were to measure the vertical movement of this flap 1 year after mammaplasty and to evaluate the factors involved. Methods The sample included 13 patients who had previously undergone bariatric surgery. The position of a titanium marker attached to the Ribeiro flap was compared on chest radiographs taken 1 day and 1 year after the mammaplasty. The significance level was set at 5%. Results All of the titanium markers moved 0.6 cm to 4.1 cm caudally during the study period (average, 2.4 cm ± 1.02 cm). The greater the weight loss after the plastic surgery, the further the marker’s descent. Weight loss between bariatric surgery and plastic surgery, the vertical dimension of the ptotic breast tissue immediately before plastic surgery, the vertical extent of the nipple-areola complex elevation during mammaplasty, the Ribeiro flap thickness and volume, and the breast volume after mammaplasty were not associated with the vertical movement of the flap. Conclusions The Ribeiro flap employed in mammaplasty of patients who previously underwent bariatric surgery undergoes ptosis that is exacerbated by weight loss after mammaplasty. Level of Evidence: 4