Pedicled local flaps: a reliable reconstructive tool for partial breast defects

Abstract

Background: Breast conserving surgery (BCS) followed by radiotherapy has gained great popularity in the treatment of breast cancer over the past years. However, radiation therapy can lead to many unfavourable aesthetic outcomes including significant volume/skin deficiency, nipple areola complex distortion and skin contraction. We present our experience in using pedicled perforator flaps to tackle the resultant partial breast defects or deformities. Methods: A retrospective data analysis study on Thirty patients with post breast conserving surgery (BCS) partial breast defects who were managed with pedicled per-forator flaps including muscle sparing latissimus dorsi muscle flap (MSLD), thoraco-dorsal artery perforator flap (TDAP) and intercostal artery perforator flap (ICAP) in the period between December 2008 and December 2018.Results: Defects were in all quadrants apart from the upper inner quadrant. The reconstructive techniques included TDAP flap 6/30 (20%), MSLD flap 20/30 (66.7%), AICAP flap 4/30 (13.3%). Age ranges 22-35 (mean 29). All flaps showed complete survival, one nipple areola complex superficial epidermolysis was experienced, and one patient presented with fat necrosis. No resultant donor site morbidity apart from scar revision for excess skin at the axillary fold in one patient. The overall satisfaction reached 94% with only 8 patients who required lipofilling to maximize the cosmetic outcome. Conclusions:The availability of a range of reliable techniques including thoracodorsal/intercostal artery perforator flap (TAP/ICAP) and muscle sparing lattissimus dorsi flap (MSLD) allow optimum results to be achieved in the treatment of partial breast defects following breast conserving surgery.

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

“…Subjective assessment of the aesthetic results was described in 3 studies. 23 , 29 , 32 In detail, the achievement of satisfactory outcome in 100% of cases was reported in 2 articles, and 92.85% satisfaction was reported in the third study. Yang et al 26 analyzed the use of different types of local flaps in partial breast defects, reporting similar results in terms of aesthetic satisfaction with LD flap and the TDAP flap showing higher scores than the others (lateral thoracodorsal flap, thoracoepigastric flap, and intercostal artery perforator flap).…”

“…1 ). Among the 12 selected studies, 18 , 23 – 33 6 were retrospective studies 23 , 25 , 26 , 29 , 32 (1 case control study 27 ) and 6 were prospective studies 18 , 24 , 28 , 30 , 31 , 33 (1 randomized control study 33 ; Tables 1 – 3 ). A total of 337 patients were included and the sample size of each study ranged from 8 to 78 patients.…”

“…Regarding flap design, some authors 18 , 24 , 25 , 29 , 32 , 33 suggested extending the ellipse-shaped skin paddle over the anterior border of the LD muscle to include possible septocutaneous perforator vessels (located anteriorly to the LD muscle) and/or to reach the lateral border of the inframammary fold. In 4 studies, 28 , 31 – 33 the skin paddle was oriented transversally (Fig.…”

“…However, the author specified that additional perforator and muscle dissection were needed in some cases. In a series of delayed partial breast defect reconstructions, Youssif et al 32 described the creation of a tunnel from the donor site to the breast at approximately 4 o’clock position to inset the flap to preserve the natural lateral breast border with no disruption of the axillary silhouette. Jacobs et al 29 reported that, at times, a limited back-cut into the anterior border of the LD inferior to the perforator was helpful to facilitate the rotation.…”

“…Amin et al 31 reported that the average time needed to regain the full range of motion of shoulder joints after MS-LD type-I or TDAP operation was 10 days with a range of 7–16 days. Although a formal evaluation of shoulder morbidity was not performed, Youssif et al 32 reported that no patient described shoulder muscle power deficit.…”