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Unilateral breast reconstruction using bilateral inferior gluteal artery perforator flaps.

Satake T, Muto M, Ogawa M, Shibuya M, Yasumura K, Kobayashi S, Ishikawa T, Maegawa J - Plast Reconstr Surg Glob Open (2015)

Bottom Line: Donor-site asymmetry is also a major disadvantage.A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon.Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps).

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.

ABSTRACT

Background: For reconstructing moderate-to-high projection breasts in iparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity.

Methods: We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon.

Results: Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps).

Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative.

No MeSH data available.


Related in: MedlinePlus

Case 2. A, Preoperative view of a 33-year-old iparous patient with left breast ductal carcinoma in situ before skin-sparing mastectomy and immediate breast reconstruction using bilateral IGAP flaps. B, Postoperative view of the patient at 2 years after immediate breast reconstruction.
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Figure 3: Case 2. A, Preoperative view of a 33-year-old iparous patient with left breast ductal carcinoma in situ before skin-sparing mastectomy and immediate breast reconstruction using bilateral IGAP flaps. B, Postoperative view of the patient at 2 years after immediate breast reconstruction.

Mentions: Because the gluteal skin color and texture differ from those of native breast skin, IGAP flaps are especially indicated for nipple-sparing (Fig. 2) or skin-sparing mastectomy patients (Fig. 3). For delayed reconstruction after modified radical mastectomy, tissue expansion is indicated before reconstruction (Fig. 4).


Unilateral breast reconstruction using bilateral inferior gluteal artery perforator flaps.

Satake T, Muto M, Ogawa M, Shibuya M, Yasumura K, Kobayashi S, Ishikawa T, Maegawa J - Plast Reconstr Surg Glob Open (2015)

Case 2. A, Preoperative view of a 33-year-old iparous patient with left breast ductal carcinoma in situ before skin-sparing mastectomy and immediate breast reconstruction using bilateral IGAP flaps. B, Postoperative view of the patient at 2 years after immediate breast reconstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4387136&req=5

Figure 3: Case 2. A, Preoperative view of a 33-year-old iparous patient with left breast ductal carcinoma in situ before skin-sparing mastectomy and immediate breast reconstruction using bilateral IGAP flaps. B, Postoperative view of the patient at 2 years after immediate breast reconstruction.
Mentions: Because the gluteal skin color and texture differ from those of native breast skin, IGAP flaps are especially indicated for nipple-sparing (Fig. 2) or skin-sparing mastectomy patients (Fig. 3). For delayed reconstruction after modified radical mastectomy, tissue expansion is indicated before reconstruction (Fig. 4).

Bottom Line: Donor-site asymmetry is also a major disadvantage.A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon.Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps).

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.

ABSTRACT

Background: For reconstructing moderate-to-high projection breasts in iparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity.

Methods: We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon.

Results: Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps).

Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative.

No MeSH data available.


Related in: MedlinePlus