Local Flaps for Breast-Conserving Surgery Defects

Local Flaps for Breast-Conserving Surgery Defects

Douglas R. Macmillan

Stephen J. Mcculley

Locating the Perforators

The perforators are identified using an 8-MHz handheld Doppler. Only perforators within 2 to 3 cm of the lateral breast crease and within 1 to 2 cm of the inframammary fold are of value in allowing easy delivery of the flap into the breast. In our experience and on the basis of a perforator mapping study, there are common sites for intercostal perforators as shown in Figure 36-1.

Perforators of the thoracodorsal vessels are well described (9,10). For the purpose of reconstruction of partial breast defects, to give reach and keep the donor-site scar in the inframammary fold, TDAP flap is best raised on a muscle patch using more distal perforators at the level of the bra line as described in the section that follows.

Planning a Local Perforator Flap

Although all these flaps can be planned to reach a defect anywhere in the breast, the ideal (and easiest) case is a small nonptotic breast with a laterally sited cancer. However, from our experience of over 500 cases (11), we have found the following to be common solutions to frequently encountered clinical scenarios as noted in Figures 36-2 and 36-3.

For more central defects in the upper half of the breast, including those behind the nipple, a pedicled LTAP flap is ideal. Alternatively, a LICAP flap can be extended and intervening breast tissue excised. If neither of these options is possible then a TDAP flap can be used. If a skin-bearing flap is required (e.g., if the nipple is required to be excised) then an LTAP flap again is ideal or alternatively a TDAP flap (Figs. 36-4 and 36-5).

In the lower breast, central defects can be filled with LICAP flaps based on perforators at the lateral end of

the inframammary fold. Alternatively, they can be filled with a bilobed “gullwing” flap based on intercostal perforators near the breast meridian on the inframammary fold (Figs. 36-6 and 36-7).

FIGURE 36-1 Common sites for perforators.

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Aug 25, 2021 | Posted by in Aesthetic plastic surgery | Comments Off on Local Flaps for Breast-Conserving Surgery Defects

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