Abdominal Fascial Flaps for Providing Total Implant Coverage in One-Stage Breast Reconstruction: An Autologous Solution

Abstract

There are many ways to provide soft-tissue coverage of silicone breast implants in breast reconstruction. These include acellular dermis slings, polyglycolic mesh, deepithelialized skin, and muscle. The ideal soft-tissue cover would be supple, easily harvested, of minimal morbidity, of minimal cost, and preferably autologous. We feel that the technique described here has these qualities and allows for complete coverage of silicone implants. An additional benefit of this technique is that it helps to increase the definition of the inframammary sulcus. This method is a good alternative in providing implant coverage during breast reconstruction, especially when there is a large implant or small pectoralis major muscle.

A Possible Technique for the Complex Reconstruction of Exposed Breast Implant: Applicability and Microcirculation of the Capsule Flap

“…Implant protrusion is a gradual process and its later stages require a more invasive surgical intervention. 14 Several techniques are used for the covering of implants e.g., deepithelialized skin, 15,16 abdominal fascial flaps, 17 acellular dermal matrix (ADM), [18][19][20][21] autologous dermal graft 22 and polyglycol mesh. 23 If signs of inflammation are not detected, latissimus dorsi flaps or local perforator flap can be applied.…”

The Superiorly Based Partial Rectus Abdominis and External Oblique Flap: A New Technique for Breast Asymmetry Reconstruction

“…The SPREO flap aims to utilize the inherent strengths of the flaps described by Bohmert 7 in 1991 and Isken et al 8 in 2009, while improving the quality and morbidity profile of the flap.…”

“…Isken et al 8 in 2009 described a similar technique in which they harvested a superiorly based flap made up of external oblique fascia and anterior rectus sheath over the upper abdomen to cover the lower pole of a prosthesis. The difference being that the flap that Isken et al 8 described was primarily a fascial flap. If the fascial flap appeared weak or too thin, little split muscle fibers were included in the proximal portion of the flap to provide added thickness.…”

Simple prosthesis versus prosthesis plus titanium-coated polypropylene mesh for implant-based immediate breast reconstruction after total mastectomy for breast cancer

“…The basic principle of implant coverage during the traditional breast reconstruction is the application of "muscle-covering implants"; that is, after the mastectomy, a "pocket" is created under the chest wall muscle, and the implants are placed in the pocket (2). Muscle coverage can be either "complete" (full coverage of the prosthesis with muscle) or "partial" (the pectoralis major muscle covers only the upper pole) (8)(9)(10), with an attempt to avoid the exposure or removal of the implants when flap necrosis occurs after the mastectomy. However, partial muscle coverage increases the risk of incision splitting, prosthesis exposure, and even reconstruction failure after implantation (10,11).…”