Modern techniques and alternative flaps in microsurgical breast reconstruction

Seth, Akhil K.; Allen, Robert J.

doi:10.1002/jso.25198

Cited by 16 publications

(16 citation statements)

References 67 publications

(85 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Th e statistical analysis revealed that the use of classical breast reconstruction techniques 17 , using tissue expanders and silicone implants, is an eff ective measure for the recovery of these patients. Whether we are talking about immediate implant reconstruction or two-step reconstruction after the initial tissue expansion, the duration of hospitalization is reduced when using prosthetic materials, the results are predictable and off er a high degree of patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

The Romanian National Breast Reconstruction Program - Results and Conclusions after 5 Years

Bejinariu¹,

Marinescu²,

ENESCU³

2019

Rev. Med. Mod.

View full text Add to dashboard Cite

Introduction: The optimization of the breast reconstruction treatment protocols and the introduction of state-subsidized national programs are global priorities. The present paper presents the results obtained within the National Program of Breast Reconstruction at the "Bagdasar-Arseni" Emergency Clinical Hospital, highlighting the advantages and disadvantages of the surgical techniques used. Materials and Methods: The results obtained after 71 surgical interventions were used for the study. The methodology used involved the use of demographic data, patient history, and the description of the surgical methods and techniques that were used. Results: Among the main results, the paper highlights the fact that mammary reconstruction by using the 'expander-implant' surgical technique was 5 times more frequent than the "implant-myocutaneous flap" technique. Post-operative complications have been present in 57% of the patients who associate comorbidities. Breast reconstruction using the TRAM (transverse rectus abdominis muscle 1) flap was the rescue solution for severe complications. Conclusions: The TRAM flap was proven to be the best technique in the treatment of diffi cult cases. Carrying out these statistical analyzes related to projects of a national scale form the solid foundation of documented studies that bring a signifi cant contribution to the development of the Romanian medical system.

show abstract

Section: Discussionmentioning

confidence: 99%

The Romanian National Breast Reconstruction Program - Results and Conclusions after 5 Years

Bejinariu¹,

Marinescu²,

ENESCU³

2019

Rev. Med. Mod.

View full text Add to dashboard Cite

show abstract

“…The patient is subject to radiation to obtain CTA imaging. While MRA does not involve ionizing radiation, this technique is more costly and may not be widely accessible or available to all patients (7).…”

Section: Computed Topographic Angiography (Cta) or Magnetic Resonance Angiography (Mra)mentioning

confidence: 99%

“…Based on this information, the surgeon can expertly design flaps based on preoperatively determined perforators that limit patient morbidity (i.e., those with a shorter intramuscular or no intramuscular course) and approach key perforators quickly to improve efficiency and decision-making intraoperatively (Figure 1). Additional benefits of preoperative imaging include volumetric analysis of donor and recipient sites (Figure 2) and being an adjunct tool in the training of residents and fellows (7,16,17). With regards to autologous breast reconstruction, imaging provides the surgeon with a more accurate assessment of available donor site tissue to reconstruct the breast following mastectomy, potentially alerting the clinician to the need for additional volume in the form of extended or additional flaps (18,19).…”

Section: Computed Topographic Angiography (Cta) or Magnetic Resonance Angiography (Mra)mentioning

confidence: 99%

“…The first abdominally based method for autologous breast reconstruction described by Hartrampf was the pedicled transverse rectus abdominis muscle (TRAM) flap, which relied on the superior epigastric vessels (4). As the field of microsurgery began to evolve, Holmström et al and Grotting et al popularized the free TRAM flap (5,6), based on the dominant inferior epigastric vessels, offering many advantages such as more robust perfusion, less fat necrosis and increased freedom of shaping (7). As knowledge of perforator anatomy expanded and techniques of microsurgery flourished, the deep inferior artery epigastric perforator (DIEP) flap was designed to preserve the rectus abdominis muscle, decreasing donor site morbidity associated with TRAM flaps (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Alternative flaps in autologous breast reconstruction

Myers¹,

Nelson²,

Allen³

2021

Gland Surg

View full text Add to dashboard Cite

The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction.Additionally, preoperative imaging (CTA, MRA) and novel applications (stacking flaps, neurotization) in breast reconstructive microsurgery will be discussed.

show abstract

“…These include the lumbar artery perforator, profunda artery perforator, transverse gracilis myocutaneous, superior gluteal artery perforator, inferior gluteal artery perforator, or lateral thigh perforator flaps. 39 With the appropriate patient and flap donor sites selected, the challenge then becomes flap arrangement for inset and anastomotic technique. Recipient site vessel options for free flap reconstruction include the internal mammary vessels (either antegrade or retrograde), IMA perforators, intercostal perfora-tors, circumflex scapular, or the thoracodorsal vessels.…”

Section: Videomentioning

confidence: 99%

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Muñoz

Powers

Zhang

et al. 2020

J Reconstr Microsurg

View full text Add to dashboard Cite

Background The objective of this study is to quantify the prevalence and describe the utilization of an anatomic vascular variant in which the obturator artery (OA) arises from the trunk of the deep inferior epigastric artery (DIEA) in stacked/dual-pedicled autologous breast reconstruction. When this variant is identified preoperatively on computed tomography angiography (CTA), it may be utilized in a “flow-through” fashion to direct antegrade internal mammary artery (IMA) flow into a second free flap to facilitate anastomotic arrangement and optimize perfusion. Methods Preoperatively obtained abdomen/pelvis CTA imaging of 121 autologous breast reconstruction patients were retrospectively reviewed for the unilateral or bilateral presence of the OA branch arising from the DIEA (OA variant). The results were analyzed using descriptive statistics. Results Our analysis revealed the presence of the OA variant in 60 of the 121 (49.6%) breast reconstruction candidates, either unilaterally or bilaterally. Out of these patients, the variant was present unilaterally in 33 (55%) and bilaterally in 27 (45%) patients. Of the unilateral variants, 12 (36.4%) patients demonstrated right-sided laterality, while 21 (63.6%) patients demonstrated left-sided laterality. Clinically, this anatomic variant has been utilized in several cases of autologous breast reconstruction with flap survival in all cases. Conclusion Utilization of this anatomic variant in stacked or dual-pedicled autologous breast reconstruction results in antegrade IMA perfusion of both primary and secondary flaps, as well as improved size match compared with other anastomotic options. Knowledge of the vascular anatomy and variations in the inferior epigastric system is crucial to both preventing complications and optimizing flap planning and outcome.

show abstract

Modern techniques and alternative flaps in microsurgical breast reconstruction

Cited by 16 publications

References 67 publications

The Romanian National Breast Reconstruction Program - Results and Conclusions after 5 Years

The Romanian National Breast Reconstruction Program - Results and Conclusions after 5 Years

Alternative flaps in autologous breast reconstruction

Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction

Contact Info

Product

Resources

About