Single stage reconstruction of the missing breast

Pontes, Ronaldo

doi:10.1016/s0007-1226(73)90045-3

Cited by 26 publications

(13 citation statements)

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“…In this case, a deep inferior epigastric perforator (DIEP) flap could not meet up to the desired volume, and she was against the use of a silicone breast implant. We offered the possibility of performing a breast sharing surgery using the technique earlier described by Pontes 1 and Mayer et al 7 Because prior cadaveric studies delineated the importance of the presence of the fourth intercostal mammary perforator (IMAP) for supplying the skin area from the infra-areolar region to the inframammary fold (IMF), 8 a preoperative computed tomography scan was executed, which showed no signs of any other perforator being dominant over the fourth IMAP. Figure 1 shows our patient with preoperative markings.…”

Section: Case Reportmentioning

confidence: 99%

“…When a patient, with remaining contralateral breast hypertrophy after unilateral mastectomy, declines implant reconstruction and has a lack of autologous donor-site availability, most reconstructive options diminish. A remaining option is breast sharing, first described by Pontes 1 in 1973. This technique uses otherwise discarded breast-tissue with minimal donor-site morbidity.…”

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confidence: 99%

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Breast-sharing Technique in a Unilateral Mastectomy Patient

Geerards

Kroeze

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Summary:Breast reconstruction patients frequently desire consecutive or simultaneous contralateral breast reduction. When combining the requirements of both autologous breast reconstruction with symmetrizing breast reduction, a 2-staged contralateral pedicled breast sharing is a dignified alternative. We present a 60-year-old woman with a radical mastectomy and adjuvant radiotherapy. On the contralateral side, she had a hypertrophic breast with a desire for reduction mammaplasty. A 2-stage procedure for breast sharing was planned. A preoperative computed tomography scan, to assess the status of the fourth intercostal mammary perforator (IMAP), was performed. After the first procedure, symmastia was evident. Water-assisted liposuction and quilting sutures to the sternal periosteum were applied in a second procedure to correct the symmastia. We preserved the fourth intercostal perforator to provide optimal vascularization. Water-assisted liposuction and quilting sutures were used to correct the remaining symmastia and contributed to the aesthetics of both breasts. A drawback of this procedure is the need for multiple stages. Furthermore, oncological safety should be considered and surgeons should be aware of the risk for venous congestion. Breast-sharing could be a feasible alternative reconstruction for women seeking unilateral breast reconstruction with contralateral breast hypertrophy. It reduces the need for free-flap surgery and subsequent donor-site morbidity. Considering the fact that the contralateral breast must be of significant size, the indication for this type of reconstruction is limited.

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Section: Case Reportmentioning

confidence: 99%

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confidence: 99%

Breast-sharing Technique in a Unilateral Mastectomy Patient

Geerards

Kroeze

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…This technique failed to gain favor, and subsequent attempts over the first 60 years of the 20th surgery involved tubed pedicled flaps from the other breast or from distant sites. [2][3][4][5][6] These techniques were often complicated by tissue loss, multiple procedures, scars, and inadequate results.…”

Section: Historymentioning

confidence: 99%

Reconstruction Following Surgery for Breast Cancer

Karp¹,

Colen²

2005

Breast Cancer

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“…Moreover, limited availability of autologous donor sites, refusal of implants and further comorbidities can diminish the reconstruction options (Geerards et al, 2018). The breast sharing technique was first introduced by Reinhard in 1932 and reappraised by Pontes in 1973 (Pontes, 1973; Reinhard, 1932). Hence, further modified procedures using pedicled split breast flaps have been described in recent publications (Marshall, 1993; Marshall, Anstee, & Stapleton, 1981; Marshall, Anstee, & Stapleton, 1986; Morritt, Grinsell, & Morrison, 2006; Schoeller et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Unilateral breast reconstruction with the free contralateral split breast flap using supermicrosurgical anastomosis: A case report

et al. 2020

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Abstrct Consecutive or simultaneous contralateral breast reduction is a frequent request from patients undergoing unilateral breast reconstruction. Both procedures can be combined using otherwise discarded tissue as a split breast graft for reconstruction of the contralateral side. There have been few reports on the use of pedicled split breast grafts. We present a 75‐year‐old female with multicentric mammary carcinoma following chemotherapy, mastectomy, axillary lymph node dissection and radiotherapy. She requested a reconstruction of the left breast as well as reduction of the right breast. Risk factors, including heavy alcohol and tobacco dependence and COPD, limited the surgical options. While a free flap breast reconstruction was the standard feasible option, we opted for a procedure with minimal surgery‐related morbidity. The right breast was evidently tumor‐free, and the patient had no family history of breast cancer. Reconstruction was performed 22 months postmastectomy. The split‐breast free flap was based on the right internal mammary artery (IMA) perforator and harvested during the right‐sided breast reduction. Microsurgical anastomosis was performed on the IMA perforator on the left side. Mastopexy was performed on the right side and the nipple‐areola complex (NAC) was transferred to its new position as a free graft to complete the breast reduction. A tattoo of the left NAC was performed 4 months postreconstruction. There was complete flap survival with a pleasant cosmetic result. Split breast reconstruction could be an alternative to more common procedures. However, this approach is only feasible in patients with hypertrophic contralateral breast and absence of risk factors for developing a second primary breast cancer.

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Single stage reconstruction of the missing breast

Cited by 26 publications

References 1 publication

Breast-sharing Technique in a Unilateral Mastectomy Patient

Breast-sharing Technique in a Unilateral Mastectomy Patient

Reconstruction Following Surgery for Breast Cancer

Unilateral breast reconstruction with the free contralateral split breast flap using supermicrosurgical anastomosis: A case report

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