Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2009, vol. 18, nr 6, November-December, p. 657–667

Publication type: review article

Language: English

Postmastectomy Breast Reconstruction with Autologous Tissue – Free Flaps. Part II

Rekonstrukcje piersi po mastektomii tkankami własnymi – płaty wolne. Część II

Piotr Wójcicki1,2,, Mariusz Wysocki2,

1 Department of Plastic Surgery, Wroclaw Medical University, Poland

2 Department of Plastic Surgery, Specialist Medical Center, Polanica Zdroj, Poland

Abstract

Breast cancer is the most common tumor occurring in women. Loss of a breast is a profound traumatic experience. Since the breast is a symbol of femininity, beauty, and motherhood, mastectomy can result in serious disorders of psychological and aesthetic character. Advances in microsurgical techniques facilitated the development of various methods indispensable for performing even the most extensive reconstructions with achievement of a good final result, opening the possibility for effective rehabilitation and a return to normal psychosocial functioning. Postmastectomy breast reconstruction with free flaps has become the standard course of action, and the choice of flaps assures selection of the best method available for each patient. This paper is a review of the most important free tissue flaps used in postmastectomy breast reconstruction, including the free transverse rectus abdominis myocutaneous (TRAM), the deep inferior epigastric perforator (DIEP), the paraumbilical perforator (PUP), the superior and inferior gluteal, the Rubens, and the thigh lateral transverse and anterolateral thigh flaps.

Streszczenie

Rak sutka jest najczęstszym nowotworem u kobiet. Utrata piersi jest tragicznym wydarzeniem wywołującym głęboki uraz psychiczny. Pierś jest symbolem kobiecości, urody oraz macierzyństwa, dlatego mastektomia prowadzi do zaburzeń natury psychicznej i estetycznej. Rozwój technik mikrochirurgicznych pozwolił na opracowanie różnych metod umożliwiających wykonanie nawet najbardziej rozległych rekonstrukcji z końcowym dobrym wynikiem, co daje szansę na skuteczną rehabilitację i powrót do normalnego funkcjonowania psychospołecznego. Obecnie rekonstrukcje piersi po mastektomii płatami wolnym stały się standardowym postępowaniem, a wybór między poszczególnymi płatami zapewnia dobór najlepszej metody dla każdej pacjentki. W artykule opisano najważniejsze wolne płaty tkankowe stosowane w mikrochirurgicznej rekonstrukcji piersi u kobiet po mastektomii. Omówiono wolny płat skórno−mięśniowy z mięśnia prostego brzucha, perforatorowy płat DIEP, płat oparty na perforatorze okołopępkowym, płaty pośladkowe górny i dolny, płat Rubensa, a także płat boczny poprzeczny uda i płat przednioboczny uda.

Key words

breast reconstruction, free flaps, breast cancer

Słowa kluczowe

rekonstrukcje piersi, płaty wolne, rak piersi

References (66)

  1. Mathes SJ, Lang J: Breast Cancer: Diagnosis, Therapy, and Postmastectomy Reconstruction. In: Plastic Surgery. Mathes SJ (ed.), Saunders Elsevier, Philadelphia 2006, 2nd ed., Vol. 6, pp. 631–789.
  2. Kroll SS: Breast reconstruction with autologous tissue. In: The unfavorable results in plastic surgery. Avoidance and treatment. Goldwyn RM, Cohen MN, Lippincott Williams & Wilkins, Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo 2001, 3rd ed., 633–648.
  3. Lipa JE, Youssef AA, Kuerer HM, Robb GL, Chang DW: Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg 2003, 111, 1110–1121.
  4. Clough KB, O’Donoghue JM, Fitoussi AD, Nos C, Falcou MC: Prospective evaluation of late cosmetic results following breast reconstruction: I. implant reconstruction. Plast Reconstr Surg 2001, 107, 1702–1709.
  5. Hartrampf CR Jr, Bennet GK: Autogenous tissue reconstruction in the mastectomy patient: A critical review of 300 patients. Ann Plast Surg 1987, 205, 508–518.
  6. Kroll SS, Baldwin B: A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg 1992, 90, 455–462.
  7. Grotting JC, Urist MM, Maddox WA, Vasconez LO: Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg 1989, 83, 828–841.
  8. Grotting JC: immediate breast reconstruction using Free TRAM flap. Clin Plast Surg 1994, 21, 207–221.
  9. Clough KB, O’Donoghue JM, Fitoussi AD, Valstos G, Falcou MC: Prospective evaluation of late cosmetic results following breast reconstruction: II. TRAM flap reconstruction. Plast Reconstr Surg 2001, 107, 1710–1716.
  10. Alderman AK, Wilkins EG, Lowery JC, Kim M, Davis JA: Determinants of Patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 2000, 106, 769–776.
  11. Shaw WW, Watson J, Ahn CY: Alternatives in autologous free−flap breast reconstruction. In: Georgiade Plastic, Maxillofacial and Reconstructive Surgery. Georgiadae GS, Riefkohl R, Levin LS, 3rd ed., Williams & Wilkins, Baltimore, Philadelphia, London, Paris, Bangkok, Hong Kong, Munich, Sydney, Tokyo, Wrocław 1997, pp. 807–816.
  12. Hölmstrom H: The free abdominoplasty flap and its use in breast reconstruction. Scand J Plast Reconstr Surg 1979, 13: 423–427.
  13. Moran SL, Nava G, Behnam AB, Serletti JM, Behnam AH: An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plast Reconstr Surg 2003, 111, 1876–1882.
  14. Lantieri LA, Mitrofanoff M, Rimareix F, Gaston E, Raulo Y, Baruch JP: Use of circumflex scapular vessels as a recipient pedicle for autologous breast reconstruction: a report of 40 consecutive cases. Plast Reconstr Surg 1999, 104, 2049–2053.
  15. Arnez ZM, Bajec J, Bardsley AF, Scamp T, Webster MHC: Experience with 50 free TRAM flap breast reconstruction. Plast Reconstr Surg 1991, 87, 470−478.
  16. Nahabedian MY, Momen B, Galdino G, Manson PN: Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 2002, 110, 466–475.
  17. Chang DW, Wang B, Robb GL, Reece GP, Miller MJ, Evans GRD, Langstein HN, Kroll SS: Effect of obesity on flap and donor−site complication in free transversus rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 2000, 105, 1640–1648.
  18. Padubidri AN, Yetman R, Browne E, Lucas A, Papay F, Larive B, Zins J: Complications of postmastectomy breast reconstruction in smokers, ex−smokers, and nonsmokers. Plast Reconstr Surg 2001, 107, 342–349.
  19. Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GRD, Langstein HN, Kroll SS: Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg 2000, 105, 2374–2380.
  20. Sozer SO, Cronin ED, Biggs TM, Gallegos ML: The use of the transverse rectus abdominis musculocutaneous flap after abdominoplasty. Ann Plast Surg 1995, 35, 409–411.
  21. Ribuffo D, Marcellino M, Barnett GR, Houseman ND, Scuderi N: Breast reconstruction with abdominal flaps after abdominoplasties. Plast Reconstr Surg 2001, 108, 1604–1608.
  22. Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL: Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2001, 108, 78–82.
  23. Schusterman MA, Kroll SS, Weldon ME: Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap? Plast Reconst Surg 1992, 90, 255–261.
  24. Kroll SS: Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000, 106, 576–583.
  25. Kroll SS: Bilateral breast reconstruction in very thin patients with extended free TRAM flaps. Br J Plast Surg 1998, 51, 535–537.
  26. Baldwin BJ, Schusterman MA, Miller MJ, Kroll SS, Wang BG: Bilateral breast reconstruction: conventional versus free TRAM. Plast Reconstr Surg 1994, 93, 1410−1416.
  27. Moran SL, Serletti JM: Outcome comparison between free and pedicled TRAM flap breast reconstruction in obese patient. Plast Reconstr Surg 2001, 108, 1954–1960.
  28. Erdmann D, Sundin BM, Moquin KJ, Young H, Georgiade GS: Delay in unipedicled TRAM flap reconstruction of the breast: a review of 76 consecutive cases. Plast Reconstr Surg 2002, 110, 762–767.
  29. Scheufler O, Andersin R, Kirch A, Banzer D, Vaubel E: Clinical results of TRAM flap delay by selective embolization of the deep inferior epigastric arteries. Plast Reconstr Surg 2000, 105, 1320−1329.
  30. Banic A, Boeckx W, Guelickx GP, Marchi A, Rigotti G, Tschopp H: Late results of breast reconstruction with free TRAM flap: a prospective multicentric study. Plast Reconstr Surg 1995, 95, 1195–1204.
  31. Blondeel PN, Arnstein M, Verstraete K, Depuydt K, Van Landuyt KH, Monstrey SJ, Kroll SS: Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap. Plast Reconstr Surg 2000, 106, 1295–1299.
  32. Watterson PA, Bostwick J 3rd, Hester TR Jr et al.: TRAM flap anatomy correlated with a 10−year clinical experience with 556 patients. Plast Reconstr Surg 1995, 95, 1185–1194.
  33. Pennington DG, Nettle WJS, Lam P: Microvascular augmentation of the blood supply of the contralateral side of the free transverse rectus abdominis musculocutaneous flap. Ann Plast Surg 1993, 31, 123–127.
  34. Elliott LF, Eskenazi L, Beegle PH Jr, Podres PE, Drazan L: Immediate TRAM flap breast reconstruction: 128 consecutive cases. Plast Reconstr Surg 1993, 92, 217–227.
  35. Schusterman MA, Kroll SS, Miller MJ, Reece GP, Baldwin BJ, Robb GL, Altmyer ChS, Ames FC, Singletary SE, Ross MI, Balch ChM: The free transversus rectus abdominis musculocutaneous flap for breast reconstruction: one center’s experience with 211 consecutive cases. Ann Plast Surg 1994, 32, 234–241.
  36. Nahabedian MY, Manson PN: Contour abnormalities of the abdomen after transverse rectus abdominis muscle flap breast reconstruction: a multifactorial analysis. Plast Reconstr Surg 2002, 109, 81–87.
  37. Nahaedian MY, Dooley W, Singh N, Manson PN: Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconst Surg 2002, 109, 91–101.
  38. Mizgala CL, Hartrampf CR Jr, Bennett GK: Assessment of the abdominal wall after pedicled TRAM flap surgery. Plast Reconstr Surg 1994, 93, 988–1002.
  39. Kroll SS, Schusterman MA, Reece GP, Miller MJ, Robb G, Evans G: Abdominal wall strength, bulging, and hernia after TRAM flap breast reconstruction. Plast Reconst Surg 1995, 96, 616–619.
  40. Suominen S, Asko−Seljavaara S, von Smitten K, Ahovouo J, Sainio P, Alaranta H: Sequelae in the abdominal wall after pedicled or free TRAM flap surgery. Ann Plast Surg 1996, 36, 629–636.
  41. Blondeel N, Vanderstraeten GG, Monstrey SJ, Van Landuyt K, Tonnard P, Lysens R, Boeckx WD, Matton G: The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997, 50, 322–330.
  42. Arnaz ZM, Kahn U, Pogorelec D, Planinsek F: Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity. Br J Plast Surg 1999, 52, 351–354.
  43. Kroll SS: Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000, 106, 576–583.
  44. Blondeel PN: One hundred free DIEP flap breast reconstruction: a personal experience. Br J Plast Surg 1999, 52, 104–111.
  45. Wechselberger G, Schoeller T, Bauer T, Ninkovic M, Otto A, Ninkovic M: Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction. Plast Reconstr Surg 2001, 108, 162–166.
  46. Koshima I, Inagawa K, Urushibara K, Moriguchi T: Paraumbilical perforator flap without deep inferior epigastric vessels. Plast Reconstr Surg 1998, 102, 1052–1057.
  47. Schoeller T, Bauer T, Gurunluoglu R, Hussel H, Otto−Schoeller A, Piza−Katzer H, Weschselberger G: Modified free paraumbilical perforator flap: the next logical step in breast reconstruction. Plast Reconstr Surg 2003, 111, 1093–1098.
  48. Koshima I, Inagawa K, Yamamoto M, Moriguchi T: New microsurgical breast reconstruction using free paraumbilical perforator adiposal flaps. Plast Reconstr Surg 2000, 106, 61–65.
  49. Fujino T, Harashina T, Enomoto K: Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Plast Reconstr Surg 1976, 58, 371–374.
  50. Shaw WW: Mircovascular free flap breast reconstruction. Clin Plast Surg 1984, 11, 333–343.
  51. Wei FC, Suominen S, Cheng MH, Celik N, Lai YL: Anterolateral thigh flap for postmastectomy breast reconstruction. Plast Recostr Surg 2002, 110, 82–88.
  52. Evans GRD, Kroll SS: Choice of technique for reconstruction. Clin Plast Surg 1998, 25, 311–316.
  53. Shaw WW: Breast reconstruction by superior gluteal microvascular free flaps without silicone implants. Plast Reconstr Surg 1983, 72, 490−499.
  54. Allen RJ, Tucker C Jr: Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995, 95, 1207–1212.
  55. Blondeel PN: The sensate free superior gluteal artery perforator (S−GAP) flap: a valuable alternative in autologous breast reconstruction. Br J Plast Surg 1999, 52, 185–193.
  56. Le−Quang C: Two new free flaps developed from aesthetic surgery. II. The inferior gluteal flap. Aesthet Plast Surg 1980, 4, 1597–1608.
  57. Paletta CE, Bostwick J 3rd, Nahai F: The inferior gluteal free flap in breast reconstruction. Plast Reconstr Surg 1989, 84, 875–883.
  58. Taylor GI, Watson N: One−stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone. Plast Reconstr Surg 1978, 61, 494–506.
  59. Hartrampf CR Jr, Noel RT, Drazan L, Elliott LF, Bennett GK, Beegle PH: Rubens’s fat pad for breast reconstruction: a peri−iliac soft tissue free flap. Plast Reconstr Surg 1994, 93, 402–407.
  60. Taylor GI, Townsend P, Corlett R: Superiority for the deep circumflex iliac vessels as the supply for free groin flaps: experimental work. Plast Reconstr Surg 1979, 64, 595–604.
  61. Beckenstein MS, Grotting JC: Breast reconstruction with free−tissue transfer. Plast Reconstr Surg 2001, 108, 1345–1353.
  62. Elliott LF, Beegle PH, Hartrampf CR Jr: The lateral transverse thigh free flap: an alternative fog autogenoustissue breast reconstruction. Plast Reconstr Surg 1990, 85, 169–178.
  63. Yano K, Matsuo Y, Hosokawa K: Breast reconstruction by means of innervated rectus abdominis myocutaneous flap. Plast Reconstr Surg 1998, 102, 1452–1460.
  64. Yano K, Hosokawa K, Takagi S, Nakai K, Kubo T: Breast reconstruction using the sensate latissimus dorsi musculocutaneous flap. Plast Reconst Surg 2002, 109, 1897–1902.
  65. Delay E, Jorquera F, Lucas R, Lopez R: Sensitivity of breast reconstructed with the autologous latissimus dorsi flap. Plast Reconstr Surg 2000, 106, 302–309.
  66. Blondeel PN, Demuynck M, Mete D, Monstrey SJ, Van Landuyt K, Matton G, Vanderstraeten GG: Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless? Br J Plast Surg 1999, 52, 37–44.