Anterolateral Thigh Flap for Postmastectomy Breast Reconstruction

Abstract

Most postmastectomy defects are reconstructed by use of lower abdominal-wall tissue either as a pedicled or free flap. However, there are some contraindications for using lower abdominal flaps in breast reconstruction, such as inadequate soft-tissue volume, previous abdominoplasty, lower paramedian or multiple abdominal scars, and plans for future pregnancy. In such situations, a gluteal flap has often been the second choice. However, the quality of the adipose tissue of gluteal flaps is inferior to that of lower abdominal flaps, the pedicle is short, and a two-team approach is not possible because creation of the gluteal flap requires that the patient's position be changed during the operation. In 2000, five cases of breast reconstructions were performed with anterolateral thigh flaps in the authors' institution. Two of them were secondary and three were immediate unilateral breast reconstructions. The mean weight of the specimen removed was 350 g in the three patients who underwent immediate reconstruction, and the mean weight of the entire anterolateral thigh flap was 410 g. Skin islands ranged in size from 4 x 8 cm to 7 x 22 cm, with the underlying fat pad ranging in size from 10 x 12 cm to 14 x 22 cm. The mean pedicle length was 11 cm (range, 7 to 15 cm). All flaps were completely successful, except for one that involved some fat necrosis. The quality of the skin and underlying fat and the pliability of the anterolateral thigh flap are much superior to those of gluteal flaps and are similar to those of lower abdominal flaps. In thin patients, more subcutaneous fat can be harvested by extending the flap under the skin. Use of a thigh flap allows a two-team approach with the patient in a supine position, and no change of patient position is required during the operation. However, the position of the scar may not be acceptable to some patients. Therefore, when an abdominal flap is unavailable or contraindicated, the creation of an anterolateral thigh flap for primary and secondary breast reconstruction is an alternative to the use of lower abdominal and gluteal tissues.

Anterolateral thigh flap salvage following failed deep inferior epigastric artery perforator breast reconstruction

“…It may be used for reconstruction of the chest wall (9), oropharynx (10-13), head and neck (14,15), hand (16)(17)(18), lower extremity (19)(20)(21), phallus (22) and abdominal wall (23). Use of the flap for breast reconstruction was originally described by Wei et al (1) …”

“…However, situations may arise in which these flaps are not available. Contraindications to abdominal flaps include soft tissue inadequacy, previous abdominoplasty, scar presence and, controversially, plans for future pregnancy (1). Approximately 15% of women are not candidates for abdominal flap reconstruction (2).…”

“…Approximately 15% of women are not candidates for abdominal flap reconstruction (2). The gluteal artery perforator flap is often the second choice; however, the flap has inferior fat quality compared with abdominal flaps, offers short pedicles and necessitates an intraoperative position change (1). In these situations, the anterolateral thigh (ALT) flap has been used in breast reconstruction with satisfactory results (1)(2)(3).…”

“…The gluteal artery perforator flap is often the second choice; however, the flap has inferior fat quality compared with abdominal flaps, offers short pedicles and necessitates an intraoperative position change (1). In these situations, the anterolateral thigh (ALT) flap has been used in breast reconstruction with satisfactory results (1)(2)(3). Simultaneous harvest of the bilateral flaps is possible, intraoperative position change is unnecessary, and the flap is soft and pliable (1,3).…”

“…In these situations, the anterolateral thigh (ALT) flap has been used in breast reconstruction with satisfactory results (1)(2)(3). Simultaneous harvest of the bilateral flaps is possible, intraoperative position change is unnecessary, and the flap is soft and pliable (1,3).…”