Reverse Abdominoplasty for Mastectomy Defect Closure in Advanced Breast Cancer

Abstract

Background Breast cancer patients with locally advanced breast cancer who require radical mastectomy are left with large chest wall defects. This poses a significant reconstructive challenge as many high-risk patients require timely postmastectomy adjuvant therapy. While the reverse abdominoplasty technique is commonly used for aesthetic improvement of the anterior trunk, it can be also be effectively used for closure of extensive mastectomy defects in this patient population. Methods We conducted a retrospective cohort study of all consecutive patients who underwent an extensive radical mastectomy followed by immediate closure with the reverse abdominoplasty technique at a single tertiary cancer center from June 2017 to July 2022. Patients who had concurrent skin grafting or breast mound flap reconstruction were excluded. Demographic, medical, oncologic, and reconstructive data were collected. Results Six patients were treated with reverse abdominoplasty for 9 chest wall defects after surgical excision of locally advanced breast cancer. The median tumor size was 10.7 cm (range, 6.7–10 cm) and the median mastectomy weight was 865.7 g (range, 356.4–1247.7 g). On average, the operation length was 191 minutes (range, 86–257 minutes) and the postoperative length of stay was 2.2 days (range, 1–5 days). All patients underwent systemic adjuvant therapy and the median time from surgery to initiation of therapy was 44.5 days (range, 32–75 days). Conclusions Reverse abdominoplasty is a simple and safe technique to reliably close large defects after locally advanced breast cancer excision. It has a short operative time, hospital stay, and turnaround time to initiation of adjuvant therapy.

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer

“…In terms of the contour fullness and symmetry of the exposed parts of the body surface, it is particularly important to reconstruct defects after surgery for malignant tumors in the face, neck, or breast. 5,6 The thickness requirements of the flap for reconstruction of different anatomical parts of the head and neck vary greatly to a certain extent. For certain anatomical defects, such as the posterior pharyngeal wall, soft palate, pyriform sinus, and cervical esophagus, thinner skin flaps are required, which is conducive to the placement, curling, and ensuring sufficient space for the repaired anatomical structure; however, tongue reconstruction requires that the reconstructed tongue volume be large enough with more fat and less muscle, which will result in minimal postoperative significant shrinkage of the tongue volume in the long run, to meet the functional requirements of squeezing food into the pharyngeal cavity.…”

“…At present, the popular and widely used endoscopic technology is effective in reducing incision scars and hiding incisions. In terms of the contour fullness and symmetry of the exposed parts of the body surface, it is particularly important to reconstruct defects after surgery for malignant tumors in the face, neck, or breast 5,6 . The thickness requirements of the flap for reconstruction of different anatomical parts of the head and neck vary greatly to a certain extent.…”

Second-stage Reverse Abdominoplasty after Goldilocks Mastectomy: A Safe Autologous Reconstructive Option in Obese Patients

“…While this report discussed the use of the RA after GM, we have used this technique to improve asymmetries after both traditional postmastectomy flap reconstructions and partial mastectomies (unpublished data) in obese patients. Although the RA has been presented in the literature predominantly as an aesthetic procedure 7,8 or for closure after removing advanced cancers, 10 it may be useful in obese patients, who have excess subcutaneous tissue in this region and are at high risk for complications after more standard methods of reconstruction.…”

Reverse abdominoplasty as a salvage procedure for infected bilateral implant-based breast reconstruction

“…Although the usual approach is explantation, there are successful reports in the medical literature of salvage of infected expanders or implants [ 5 ]. On the other hand, reverse abdominoplasty has been described as a technique for aesthetic contouring of the upper abdomen, breast reduction, chest resurfacing, autologous breast augmentation, and closure of extensive postmastectomy anterior trunk defects [ [6] , [7] , [8] , [9] ]. Herein, we present the first case of reverse abdominoplasty as a salvage procedure for bilateral breast reconstruction with infected expanders.…”