Abstract

Chest-wall-based flap for repairing partial mastectomy defects: one flap for all defects

Sagit Meshulam-Derazon, Tal Kaufman, Ahuva Grubstein, Dean Ad-El Department of Plastic and Reconstructive Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel; Breast Radiology Unit, Radiology Department, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

Background:

Applying principles taken from the cosmetic plastic surgery lies at the base of any high standard reconstructive surgery in general and oncoplastic breast surgery in particular. A chest wall based dermoglandular flap for mastopexy first described by Ribeiro and popularised by Biggs and Graf, allows using the redundant tissue at the lower pole of the breast to increase the upper pole fullness.

The flaps applicability for oncoplastic procedures has never been described.

Objectives:

To introduce a single and reproducible tissue-rearrangement oncoplastic technique that is applicable for all quadrants lumpectomy defects in small to medium size breasts.

Methods:

Eleven small to medium size breast cancer patients with tumor involvement of more than a quarter of the breast were operated on using the chest-wall-based flap technique. The procedure is described in detail and the results are analyzed in terms of both cosmetic and oncological results.

Results:

The flap successfully reached all breast quadrants as necessary, as well as the areola-nipple complex. The resection borders were found to be free of tumor in all cases, and there were no perioperative complications. Patients rated nearly all the cosmetic parameters as “somewhat satisfied” or “very satisfied and there was no evidence of fat necrosis in the post-op mammography exams.

Conclusion:

The chest wall based flap is a versatile flap suitable for a wide range of breast lumpectomy defects. It allows a shorter learning curve with replicable results, making it applicable also for surgical oncologist and plastic surgeons less experienced with the variety of partial breast reconstruction techniques.