AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

The Semi-Lunar Transverse Inner Thigh Flap for Microvascular Breast Reconstruction: An Excellent Alternative
to Abdominal Flaps
Institution where the work was prepared: California Pacific Medical Center, San Francisco, CA, USA
Rudolf F. Buntic, MD1; Darrell Brooks, MD2; Karen M. Horton, MD, MSc2; (1)The Buncke Clinic, (2)Buncke Clinic
In many patients with previous abdominoplasty or inadequate abdominal tissue, the inner thigh flap can be used to reconstruct small and medium breasts. We
used a semi-lunar inner thigh flap based on the transverse upper gracilis (TUG) anatomy for breast reconstruction. Shape and projection make this flap an
excellent choice in selected patients requiring breast reconstruction. The procedure can be combined with immediate nipple areola reconstruction.
Methods
Between 2004 and 2006, 9 TUG flap reconstruction in 6 patients were performed. Two patients had previous abdominoplasty and failed implant reconstruction.
One patient had inadequate abdominal donor tissue; one patient had previous DIEP reconstruction with significant fat necrosis. Two patients elected to
undergo TUG flap reconstruction in lieu of abdominal tissue reconstruction. All flaps were vascularized through the internal mammary system.
The flap is harvested with a transverse skin paddle on the medial thigh, with a semi-lunar design. Markings and harvest will be outlined in detail. The flap was
shaped folding with the semi-lunar tips approximated and the apex of the central fold used as the area of maximal projection. This area could be plicated for
immediate nipple reconstruction. The gracilis muscle was used to augment lower pole fullness.
Results
The patient age ranged from 42 to 60 years old and all patients had a history of breast cancer. Five breasts were reconstructed in the face of previous radiation.
All flaps survived. One patient had to be taken back to the operating room 12 hours after reconstruction because of a venous thrombosis. This was repaired
and the flap survived without any flap loss or fat necrosis. There were no cases of skin necrosis, fat necrosis, flap loss. Patient satisfaction has been uniformly
excellent.
Discussion
Although other autologous tissue reconstruction options are available to patients that have had previous abdominoplasty and in very thin patients, in many of
these patients, the tranverse upper gracilis (TUG) flap can be used to reconstruct small and medium sized breasts. It provides a well vascularized and shapely
reconstruction. Unlike loss of the the rectus muscle, loss of the gracilis muscle does not result in any significant increase in hernias or significant donor complications.
The gracilis muscle pedicle and harvest are extremely reliable and straight forward. No intraoperative repositioning is required as in the case of gluteal
flaps, and the pedicle is of excellent quality. The donor thigh lift is and added aesthetic perk of the procedure.
Congenital Breast Deformity Reconstruction using Perforator Flaps
Institution where the work was prepared: Louisiana State University Medical School, New Orleans, LA, USA
Abhinav K. Gautam, BS; Timothy S. Mountcastle; Joshua L. Levine; Robert J. Allen; Ernest S. Chiu; LSU Health Sciences Center
Background:
Congenital breast deformities such as Poland's Syndrome, unilateral congenital hypoplasia, tuberous breast anomaly, and amastia pose a challenging plastic
surgical dilemma. The majority of patients are young, healthy individuals who seek aesthetic restoration of their breast deformities. Currently, both implant and
autologous reconstructive techniques are utilized. This study focuses on our experience with congenital breast deformity patients who underwent reconstruction
using a perforator flap.
Methods:
From 1994 to 2005, a retrospective chart review was performed on women who underwent breast reconstruction using perforator flaps to correct congenital
breast deformities and asymmetry. Patient age, breast deformity type, perforator flap type, flap volume, recipient vessels, postoperative complications, revisions,
and aesthetic results were determined.
Results:
Over an eleven year period, 12 perforator flaps were performed. All cases were for unilateral breast deformities. The patients ranged from 16 to 43 years of age.
6 patients had undergone previous correctional surgeries. Eight (n=8) flaps were used for correction of Poland's syndrome and its associated chest wall deformities.
Four (n=4) flaps were used for correction of unilateral breast hypoplasia. In all cases, the internal mammary vessels were the recipient vessels of choice.
No flaps were lost. No vein grafts were used. All patients were discharged on the fourth post-operative day. Complications encountered included seroma,
hematoma, and nipple malposition. Revisional surgery was performed in 30% of the cases. Aesthetic results varied from poor to excellent.
Conclusions:
Perforator flaps are an acceptable choice for patients with congenital breast deformities seeking autologous breast reconstruction. DIEP or SIEA flaps are performed
when adequate abdominal tissue is available; however, many young patients have inadequate abdominal tissue, thus a GAP flap can be utilized.
Perforator flaps are a safe, reliable surgical technique. In the properly selected patient, donor site morbidity and functional compromise is minimized, improved
self esteem is noted, postoperative pain is decreased, and excellent long-term aesthetic results can be achieved.
146