Internal mammary artery perforator propeller flap for contralateral mastectomy defect: A case report

Abstract

The internal mammary artery perforator (IMAP) flap can be used as either loco-regional or free flap, and provides thin flexible coverage for defects of the chest wall and cervical regions. In this report, we present a bilateral mastectomy case in which the left mastectomy defect was closed with an IMAP propeller flap harvested from the right breast. Our patient with a history of left breast conservation therapy was diagnosed invasive ductal carcinoma in her left breast 14 years later. On physical examination, the patient's left breast displayed the stigmata of radiotherapy including dark discoloration and firmness to palpation, compared to contralateral pendulous breast. After bilateral mastectomy, an IMAP flap with a size of 26 cm × 11 cm was harvested from right chest and was transposed 180 degrees clockwise in a propeller fashion to the left mastectomy defect without any tension. The flap survived without any complication and the patient was free of recurrence or metastases during the follow-up of 18 months. The patient was satisfied with the outcome. IMAP propeller flap could be harvested safely to the anterior axillary fold in the subcutaneous fat plane. It may provide a large skin paddle especially in large breasted women. © 2016 Wiley Periodicals, Inc. Microsurgery 36:507-510, 2016.

Contralateral internal mammary artery perforator flap for large inner chest wall defect repair and immediate breast reconstruction after excision of large malignant inner breast tumors

“…Additionally, as published previously (Dolen et al, 2016), the anatomy of the second and third IMAP flaps ensures the acquisition of a sufficient flap volume. When we separated the vascular tip, we did not pursue skeletal treatment; instead, based on preoperative vascular imaging, we separated it to the perivascular area with an overlay of 0.5 to 0.8 cm of fatty tissue to avoid damage and excessive traction of the tip.…”

“…Most previous reports (Dolen et al, 2016; Novo‐Torres et al, 2015; Schoeller et al, 2001) have indicated that hypertrophic breasts of women who have undergone mastectomy are suitable for contralateral breast reconstruction. Additionally, He et al (2020) demonstrated that the lower part of the breast was the best choice for contralateral breast reconstruction.…”

“…The postoperative VE and HE values were 0.63 and 0.56, respectively. No signs of tumor recurrence or metastasis were observed during the 43-month follow-up period.5 | DISCUSSIONAlthough the current standard for autologous breast reconstruction involves the use of the DIEP flap, we showed that the contralateral IMAP flap is safe and results in an aesthetically pleasing appearance.The dual role of the IMAP flap in immediate chest wall defect repair and breast reconstruction for patients with advanced inner breast cancer has been rarely reported.Most previous reports(Dolen et al, 2016;Novo-Torres et al, 2015;Schoeller et al, 2001) have indicated that hypertrophic breasts of women who have undergone mastectomy are suitable for contralateral breast reconstruction. Additionally, He et al (2020) demonstrated that the lower part of the breast was the best choice for contralateral breast reconstruction.…”

Perforator-Based Cross Midline Flaps of the Trunk: A Paradigm Shift in Flap Design

“…Table 3 reviews the existing studies focused on ipsilateral IMAP flaps. 4,[9][10][11][12][13][14][15][16] The maximum dimensions of flaps (in centimeters), the maximum length (in centimeters), and the maximum corresponding area in different case series published on deltopectoral IMAP. There was a total of 22 cases in which the IMAP flap was used.…”

Review of Procedures for Reconstruction of Soft Tissue Chest Wall Defects Following Advanced Breast Malignancies

“…The flap is especially beneficial in women with large breasts with a flap size reported of up to 26 cm × 11 cm, which can be saved from a breast undergoing a prophylactic mastectomy. 19 Unfortunately, lack of excess skin tissue in women with smaller breasts may necessitate the need for backgrafting of the donor site. The poor cosmesis of this flap lends it as a backup solution for coverage as the donor nipple can end in an odd location and because the pivot point of the flap can be bulky over the sternum.…”