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

Abstract

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.

Breast augmentation using a free lateral thoracic artery perforator flap from the contralateral breast: A case report

“…Scaglioni et al reported harvesting a free flap based on the IMA perforators from the contralateral breast (Scaglioni et al, 2020). Unlike in our case, the authors performed a medial incision superiorly on the chest wall and sacrificed the donor side NAC.…”

“…Breast‐sharing pedicled flaps from the contralateral breast have been described for many years (Marshall et al, 1981; Schoeller et al, 2001). Recently, free tissue transfer from the contralateral breast based on the thoracoacromial and internal mammary perforators has been performed (He et al, 2020; Scaglioni et al, 2020). The long thoracic artery perforator (LTAP) flap is well‐established as a pedicled flap for ipsilateral breast‐conserving surgery (Martellani et al, 2019; McCulley et al, 2015).…”

Double‐pedicle unaffected split‐breast flap for unilateral breast reconstruction

“…Reduction mammoplasty of the unaffected contralateral breast can help achieve breast symmetry in patients with a hypertrophic and ptotic breast. Previous studies have reported about breast reconstruction using a pedicled or free flap harvested from tissues commonly disposed in reduction mammoplasty of the unaffected breast (Caggiati et al, 2017; Dian et al, 2009; Geerards et al, 2018; He et al, 2020; Holdsworth, 1956; Kalender & Guliyeva, 2020; Lopez et al, 2020; Marshall, 1993; Marshall et al, 1981; Mayer et al, 2016; Morritt et al, 2006; Novo‐Torres et al, 2015; Pontes, 1973; Scaglioni et al, 2020; Schoeller et al, 2001; Sharp et al, 2021).…”

“…Two approaches are used in this technique. That is, the contralateral unaffected breast is dissected into half either vertically (Dian et al, 2009; Geerards et al, 2018; Mayer et al, 2016; Pontes, 1973; Scaglioni et al, 2020) or horizontally (Caggiati et al, 2017; He et al, 2020; Holdsworth, 1956; Kalender & Guliyeva, 2020; Lopez et al, 2020; Marshall, 1993; Marshall et al, 1981; Morritt et al, 2006; Novo‐Torres et al, 2015; Schoeller et al, 2001; Sharp et al, 2021).…”

“…In the vertical dissection (Dian et al, 2009; Geerards et al, 2018; Mayer et al, 2016; Pontes, 1973; Scaglioni et al, 2020), the inner side of the nipple and areola is nourished by the internal mammary perforators (IMAPs), and the remaining outer side of the other half is nourished by the lateral thoracic vessel (LTA/V). After dissection, the lateral half tissue is used as a pedicle flap for the unaffected site reduction mammoplasty, while the medial half can be transferred to the affected site as a pedicled flap (Dian et al, 2009; Geerards et al, 2018; Mayer et al, 2016; Pontes, 1973) or as a free flap (Scaglioni et al, 2020).…”