Defining the Role of Free Flaps in Partial Breast Reconstruction

Smith, Mark L.; Molina, Bianca J.; Dayan, Erez; Jablonka, Eric M.; Okwali, Michelle; Kim, Julie N.; Dayan, Joseph H.

doi:10.1055/s-0037-1607363

Cited by 15 publications

(13 citation statements)

References 27 publications

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“…Particular defect locations such as the medial or superior breast can also be challenging to reconstruct with pedicled flaps. 8,9 Limitations of this study include its small sample size and short mean follow-up length. Patientreported outcomes, objective aesthetic evaluations, and cost-analysis comparisons with traditional volume-replacement techniques are the subjects of ongoing studies.…”

Section: Discussionmentioning

confidence: 98%

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The free superficially-based low abdominal mini (SLAM) flap for oncoplastic breast reconstruction

Salibian

Swerdlow

Kondra

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Summary: Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic reconstruction is limited, and reconstruction has often required sacrifice of potential future donor sites. The free superficially based low-abdominal mini (SLAM) flap uses a narrow strip of lower abdominal tissue based on superficial perfusion of the abdominal wall that is anastomosed to chest wall perforators to preserve the ability to perform future abdominally based autologous breast reconstruction. Five patients underwent reconstruction with SLAM flaps for immediate oncoplastic reconstruction. Their mean age was 49.8 years, and their mean body mass index was 23.5. Tumor location was most commonly in the lower outer quadrant (40%). Average lumpectomy weight was 30 g. Two flaps were based on the superficial inferior epigastric artery, and three, on the superficial circumflex iliac artery. Recipient vessels included internal mammary perforators (40%), serratus branch (20%), lateral thoracic vessel branch (20%), and lateral intercostal perforators (20%). All patients underwent radiation therapy without delay and maintained volume, symmetry, and contour at an average period of 11.7 months after surgery. There were no cases of flap loss, fat necrosis, or delayed wound healing. The free SLAM flap allows for immediate oncoplastic breast reconstruction in thin, small-breasted patients with limited regional tissue without sacrificing future potential donor sites for autologous breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionmentioning

confidence: 98%

“…Reports of free flaps for partial breast reconstruction have included the superficial inferior epigastric artery (SIEA) flap 7,8 as well as deep inferior epigastric artery perforator (DIEP) and thigh-based flaps. 9 The majority of these procedures, however, were performed in the delayed setting and resulted in sacrifice of traditional autologous donor sites.…”

mentioning

confidence: 99%

The free superficially-based low abdominal mini (SLAM) flap for oncoplastic breast reconstruction

Salibian

Swerdlow

Kondra

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Microvascular partial breast reconstruction was first described by Rizzuto et al in 2004 in which a superficial inferior epigastric artery (SIEA) flap was used to reconstruct a partial mastectomy defect in a delayed fashion after completion of radiation (17). Since then, multiple small series have utilized both abdominal and non-abdominal donor sites for oncoplastic breast reconstruction in the immediate, delayed-immediate and delayed settings (18)(19)(20).…”

Section: Microvascular Oncoplastic Reconstructionmentioning

confidence: 99%

“…Typically, volume goals for the therapeutic breast in oncoplastic reconstruction are made slightly larger than the contralateral to account for radiation fibrosis and shrinkage (30). Spiegel et al designed flaps around 20% larger than the respective defect to account for radiation changes in immediate cases (20) whereas Smith et al advocate for achieving breast symmetry without oversizing regardless of timing (19). The latter authors recommend addressing radiation volume loss by reducing the contralateral breast; however, patient desiring to preserve as Flap design in abdominally-based reconstructions is particularly critical if attempting to preserve the abdomen for potential future total breast reconstruction.…”

Section: Flap Designmentioning

confidence: 99%

Microsurgery in oncoplastic breast reconstruction

Salibian¹,

Patel²

2023

Gland Surg

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Oncoplastic breast reconstruction has allowed for the optimization of oncologic and reconstructive outcomes after breast-conserving surgery (BCS). Volume replacement procedures in oncoplastic reconstruction most commonly utilize regional pedicled flaps, though several studies have reported benefits to free tissue transfer for oncoplastic partial breast reconstruction in the immediate, delayed-immediate and delayed settings. Microvascular oncoplastic breast reconstruction is a useful technique in the appropriate patients with small-to-medium size breasts and larger tumor-to-breast ratios who desire to preserve breast size, those with a paucity of regional breast tissue and patients that wish to avoid chest wall and back scars. Several free flap options for partial breast reconstruction exist, including superficially-based abdominal flaps, medial thigh-based flaps, deep inferior epigastric artery perforator (DIEP) flaps and thoracodorsal artery-based flaps. However, special consideration should be given to preserving donor sites for potential future total autologous breast reconstruction with any flap choice that should be tailored to individual recurrence risk. Aesthetically placed incisions should take recipient vessel access into consideration which include the internal mammary vessels and perforators medially, and then intercostal, serratus branch and thoracodorsal vessels laterally. The utilization of a thin strip of lower abdominal tissue based on the superficial abdominal circulation allows for a well-concealed donor site with minimal morbidity and preservation of the abdominal donor site if future total autologous breast reconstruction is needed.Optimizing outcomes requires a team-based approach to appropriately design recipient and donor-site considerations while individualizing tumor and patient-specific plans.

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“…Masetti et al developed a four-step design for oncoplastic operations which can be applied in several cases. 21,37,38 Fundamentally, oncoplastic procedures attempt to minimize cosmetic detriment to the breast.…”

Section: Partial Breast Defects Classification and Oncoplastic Technimentioning

confidence: 99%

Investigation into breast cancer and partial breast reconstruction: A review

et al. 2019

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Growing increasingly in South America, Africa and Asia, breast cancer is known as the dominant type of cancer in women. Different treatments are available for breast cancer, among which surgery is the most widely used, but researchers are trying to develop new strategies. One of the most prominent surgical methods is referred to as oncoplastic surgery, that helps to remove segments of malignant breast tissue. This type of surgery aims to obtain vast surgical margins, while the remaining tissue is rearranged so that the better cosmetic outcome is obtained. This review will investigate the breast cancer and then discuss partial breast reconstruction. Before outlining the procedures, the different types of partial breast reconstruction will be discussed. Finally, advantages and disadvantages will be outlined. MEDLINE database was used to conduct the search. The main terms used were ‘Conservation Breast Surgery Reconstruction’ AND ‘Oncoplastic Surgery’, ‘Partial Mastectomy Reconstruction’ AND ‘Conservative Breast Surgery Reconstruction’, ‘oncoplastic’ [All Fields], ‘breast’ AND ‘surgery’ OR ‘surgery’ operative’, ‘oncoplastic’ (‘breast’)’. The bibliographies of relevant papers were manually searched up to October 2018, but more recent voices are also included.

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Defining the Role of Free Flaps in Partial Breast Reconstruction

Cited by 15 publications

References 27 publications

The free superficially-based low abdominal mini (SLAM) flap for oncoplastic breast reconstruction

The free superficially-based low abdominal mini (SLAM) flap for oncoplastic breast reconstruction

Microsurgery in oncoplastic breast reconstruction

Investigation into breast cancer and partial breast reconstruction: A review

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