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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 3. A, Bilateral IGAP flaps were elevated with a 5.5 × 25.0 cm lazy-S shaped skin paddle, 3.5 cm superior and 2.0 cm inferior adiposal lobe. B, Bilateral IGAP flaps were anastomosed and inset into the breast skin pocket with the left breast lifted upward using surgical tape to reconstruct the mild breast ptosis.
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Figure 8: Case 3. A, Bilateral IGAP flaps were elevated with a 5.5 × 25.0 cm lazy-S shaped skin paddle, 3.5 cm superior and 2.0 cm inferior adiposal lobe. B, Bilateral IGAP flaps were anastomosed and inset into the breast skin pocket with the left breast lifted upward using surgical tape to reconstruct the mild breast ptosis.

Mentions: Before flap harvesting, redesign of the skin paddle and fat pad outline based on the mastectomy specimen or anticipated tissue defect is again performed. The incision is made along the skin markings, and subcutaneous dissection is performed above the superficial fascial plane to harvest an ample amount of adipose tissue in the flap. The adiposal lobe including the flap is extended more superiorly to maximize transferable tissue as necessary (Fig. 8A). Dissection then proceeds laterally to medially under the deep fascia of the gluteus maximus muscle to detect the perforators. During dissection, you will observe large drops of fat arranged in a deep layer on the iliotibial tract and light color fat preserved on the ischium. Proceeding with subfascial dissection, several musculocutaneous perforators arise from the inferior gluteal vessels at the inferior half of the gluteus maximus muscle. Among them, we select 1 or 2 large perforators located close to the medial or lateral one third of the IGAP flap to facilitate easy microsurgical anastomosis and flap inset (Fig. 9A). For deeper dissection into the gluteus maximus and down to the sacral fascia, a large surgical field with wide splitting of the originating muscle is required for safety and easy development. Pedicle dissection proceeds toward its origin from the inferior gluteal vessel to harvest the desired pedicle length and vessel diameter. Under the sacral fascia, the perforating artery and vein diameter differ from each other and have multiple communications with several branches that must be ligated before pedicle resection. After assessing flap perfusion with indocyanine green angiography, the pedicles of both IGAP flaps are divided and donor wounds are closed.


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 3. A, Bilateral IGAP flaps were elevated with a 5.5 × 25.0 cm lazy-S shaped skin paddle, 3.5 cm superior and 2.0 cm inferior adiposal lobe. B, Bilateral IGAP flaps were anastomosed and inset into the breast skin pocket with the left breast lifted upward using surgical tape to reconstruct the mild breast ptosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4387136&req=5

Figure 8: Case 3. A, Bilateral IGAP flaps were elevated with a 5.5 × 25.0 cm lazy-S shaped skin paddle, 3.5 cm superior and 2.0 cm inferior adiposal lobe. B, Bilateral IGAP flaps were anastomosed and inset into the breast skin pocket with the left breast lifted upward using surgical tape to reconstruct the mild breast ptosis.
Mentions: Before flap harvesting, redesign of the skin paddle and fat pad outline based on the mastectomy specimen or anticipated tissue defect is again performed. The incision is made along the skin markings, and subcutaneous dissection is performed above the superficial fascial plane to harvest an ample amount of adipose tissue in the flap. The adiposal lobe including the flap is extended more superiorly to maximize transferable tissue as necessary (Fig. 8A). Dissection then proceeds laterally to medially under the deep fascia of the gluteus maximus muscle to detect the perforators. During dissection, you will observe large drops of fat arranged in a deep layer on the iliotibial tract and light color fat preserved on the ischium. Proceeding with subfascial dissection, several musculocutaneous perforators arise from the inferior gluteal vessels at the inferior half of the gluteus maximus muscle. Among them, we select 1 or 2 large perforators located close to the medial or lateral one third of the IGAP flap to facilitate easy microsurgical anastomosis and flap inset (Fig. 9A). For deeper dissection into the gluteus maximus and down to the sacral fascia, a large surgical field with wide splitting of the originating muscle is required for safety and easy development. Pedicle dissection proceeds toward its origin from the inferior gluteal vessel to harvest the desired pedicle length and vessel diameter. Under the sacral fascia, the perforating artery and vein diameter differ from each other and have multiple communications with several branches that must be ligated before pedicle resection. After assessing flap perfusion with indocyanine green angiography, the pedicles of both IGAP flaps are divided and donor wounds are closed.

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