Breast Reconstruction with a Transverse Abdominal Island Flap

Fujino was the first to introduce gluteal tissue as a free flap for breast reconstruction. The use of the musculocutaneous flap from the buttock in breast reconstruction has been championed by Shaw. Despite the initial enthusiasm for this area as a donor site, few other large series exist on the subject. Two decades of experience with this region as a donor site led to recognition of advantages and drawbacks. Furthermore, use of both the superior and inferior gluteal musculocutaneous flap was associated with certain important donor site complications and the use of vein grafts to allow for microvascular anastomosis. The evolution of free tissue transfer has progressed to the level of the perforator flap. This reconstructive technique allows elevation of tissue from any region consisting only of fat and skin. This minimizes donor site morbidity by allowing preservation of the underlying muscle and coverage of important structures in the region such as nerves. The superior and inferior gluteal perforator flaps have been used at our institution for breast reconstruction since 1993. The superior gluteal artery perforator (S-GAP) flap is our preferred method of breast reconstruction when the abdomen is not available or preferable. We report the result of this flap over the past 9 years and point out important surgical refinements, advantages, disadvantages, and lessons learned during this time.

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“…Autologous tissue reconstruction allows the creation of a soft, symmetric, and esthetically pleasing breast mound [11][12][13] (Figs. 7 and 8).…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, the abdomen is usually chosen as a donor site. 8,[11][12][13] However, in approximately 20% of patients who undergo mastectomy, the abdomen might not be a suitable 3,9,10 donor site. The back, 14,15 buttocks, [1][2][3][4][5] and thighs 16 -19 serve as alternative sites for breast reconstruction in those cases.…”

mentioning

confidence: 99%

Breast Reconstruction With Gluteal Artery Perforator (GAP) Flaps

Guerra

Metzinger

Bidros

et al. 2004

Annals of Plastic Surgery

137

104

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“…The transverse rectus abdominis myocutaneous (TRAM) flap was first described by Holmström [1] and popularized by Hartrampf et al [2] and Gandolfo [3]. The TRAM flap allows breast reconstruction with analogous tissue, providing a natural appearance and consistency, and long-lasting results [4–7].…”

Section: Introductionmentioning

confidence: 99%

“…There are many different techniques for creating flaps, such as deep inferior epigastric perforator flaps and unipedicled [2, 3], bipedicled [8], and microsurgical [1] TRAM flaps. However, these techniques create defects of various levels of severity in the abdominal wall, with abdominal hernia and bulge being the most common late complications [4, 9].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap

et al. 2010

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The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P < 0.05) among patients with body mass index (BMI) ≥ 30 kg/m2 (hernia incidence, 15.0%) than that among patients with BMI <30 kg/m2 (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P < 0.05) among patients with BMI ≥ 30 kg/m2 (abdominal bulge incidence, 5.0%) than that among patients with BMI ≥ 30 kg/m2 (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P < 0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients.

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“…The LD is often combined with an implant for use in a single-stage procedure, where it serves to improve coverage of the prosthesis and improve the final breast contour [38] (Figure 4). The TRAM (Transverse Rectus Abdominus Myocutaneous flap) [39] can be used either as a local pedicle or a free tissue transfer flap [40]. In one study, comparing 85 patients undergoing TRAMs, implant-based or LD reconstructions, the mobility and consistency of the reconstructed breast are more closely resembled the natural breast in patients with TRAM flaps [41].…”

Section: Autologous Flapsmentioning

confidence: 99%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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Breast Reconstruction with a Transverse Abdominal Island Flap

Cited by 1,021 publications

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Breast Reconstruction With Gluteal Artery Perforator (GAP) Flaps

Breast Reconstruction With Gluteal Artery Perforator (GAP) Flaps

Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

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