Autologous Breast Augmentation by Pedicled Perforator Flaps

Abstract

A technique is described for autologous breast augmentation based on perforator flaps of the lateral chest wall. Raising these flaps as perforator flaps implies minimal donor site morbidity; however, the price to pay is a scar underneath the armpit extending from the lateral end of the inframammary fold onto the back. This scar can be relatively well hidden underneath the arm and in the brassiere. Indications depend on the aversion of the patient against prostheses and the extent of available tissue versus the desired augmentation. As typical indications, we would consider the occasional developmental asymmetry, autologous augmentation after contralateral breast reconstruction, or contour surgery in the bariatric patient.

The versatility of the inter-costal artery perforator (ICAP) flaps

“…15,16 We reported the first use of the LICAP in partial breast reconstruction within a clinical algorithm based on the location of the defect and the availability of these perforators. 15 This flap is suitable for defects, which extend on the lateral quadrants of the breast.…”

Surgical Technique in Pedicled Thoracodorsal Artery Perforator Flaps: A Clinical Experience with 99 Patients

“…3,7,15,16 Recent studies demonstrate only 5.5 Ϯ 1.8 perforators with a diameter greater than 0.5 mm supplying this flap. 15 However, only one or two perforators can be clinically used if a useful arc of rotation is to be maintained.…”

“…The main indications are in breast surgery, either in partial breast reconstruction after ablative surgery 6 or in autologous augmentation. 7 The flap reaches the superolateral, inferolateral, and inferomedial quadrants of the breast. Flaps 15 cm wide can be raised safely on a single perforator, depending on the recipient-site requirements and the ability to achieve primary closure of the donor site.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Although the thoracodorsal artery perforator flap has been reportedly used in multiple reconstructive situations, it has not gained the popularity of other perforator flaps such as the deep inferior epigastric artery perforator flap. Reasons for this include inconsistent perforator size, quality, quantity, and location, all of which contribute to tedious dissection.…”

“…4,11,12 Thus, only small clinical series of thoracodorsal artery perforator flaps have been published. [1][2][3][4][5][6][7][8][9][10][11][12] The thoracodorsal artery perforator flap has been used widely in our department as either a free 9 or a pedicled flap. 6 The purpose of this article is to report our clinical experience with a large series of pedicled thoracodorsal artery perforator flaps used for a variety of indications, with an emphasis on preoperative planning, safe and standardized dissection technique, and an analysis of major and minor postoperative complications.…”