Choice of flaps for breast reconstruction

Abstract

The optimal method for breast reconstruction should be safe, reliable, and accessible for every patient, and it should display little or no donor-site morbidity. After comparing mammary implants it has been found that autogenous breast reconstruction can create a ptotic, soft, symmetrical breast mound. The transverse rectus abdominis musculocutaneous flap (TRAM) remains the most popular method for autogenous reconstruction. Modern trends in breast reconstruction using the TRAM flap have promoted adequate blood supply to the flap while minimizing donor-site defects in the anterior abdominal wall. The pedicled TRAM flap remains one of the most frequently used flaps, but the indirect blood supply in this flap has required many modifications and refinements. Such modifications have included the bipedicled TRAM flap, the free TRAM flap, and the supercharged TRAM flap. To avoid donor-site morbidities, the muscle-sparing free TRAM, deep inferior epigastric perforator flap (DIEP), and superficial inferior epigastric artery (SIEA) flap were introduced. The DIEP perforator flap requires meticulous technique but offers proven reliability and a low rate of complications. As surgeons become more comfortable with harvesting DIEP flaps, the frequency of usage seems likely to increase. The latissimus dorsi musculocutaneous flap, gluteus maximus musculocutaneous flap, and others may be selected when these modifications of free TRAM flap are unavailable or unusable.

Comparison of Three Methods for the Derivation of a Biologic Scaffold Composed of Adipose Tissue Extracellular Matrix

“…These options generally include the use of autologous tissue transplantation. 1,2 Although these methods are generally sufficient for tissue repair, there are a number of limitations regarding the long-term survival and functionality of the transplanted tissue. These include both donor-and recipient-site morbidity, with many adipose tissue transplants experiencing volume reduction and necrosis due to disruption of the vascular supply.…”

Free deep inferior epigastric perforator flap after abdominal liposuction: reconsidering a contraindication

“…The DIEP flap, introduced by Itoh and Arai [9] and Koshima and Soeda [10] and popularized by Allen and Treece, [11] Blondeel and Boeckx, [12] and Blondeel [13] has been described as the most appropriate way to reconstruct a breast to minimize donor morbidity. [6,14,15] The effect of liposuction on a free flap donor site months or years before flap transfer remains to be clarified. Previous literature has shown conflicting evidence regarding the effect of liposuction on donor tissue, specifically, perforator vessels.…”

“…[2] Numerous articles have already demonstrated successful breast reconstruction with a transverse rectus abdominis myocutaneous flap after liposuction; however, there is a paucity of data on breast reconstruction using a deep inferior epigastric perforator (DIEP) flap after liposuction. [3][4][5][6] Our experience of breast reconstruction with DIEP flap after abdominal wall liposuction will be demonstrated in addition to a literature review.…”

Modified Extended Latissimus Dorsi Myocutaneous Flap with Added Vascularised Chest Wall Fat in Immediate Breast Reconstruction after Conservative (Sparing) Mastectomies

“…iv. Others; superior gluteal artery perforator flap (SGAP) (Allen & Tucker, 1995), the lateral thigh flap (Elliot et al, 1990), The Rubens flap, or deep circumflex iliac soft tissue flap (Tachi & Yamada, 2005).…”