[Secondary microsurgical reconstruction of the breast and free inferior gluteal flap]

A technique of secondary breast reconstruction by microsurgical transfer of an inferior gluteal flap is presented. The principal characteristics of the inferior gluteal myocutaneous flap, described for the first time by the author in 1978, are presented: anatomical bases, harvesting technique. Breast reconstruction with this flap is performed in three operative steps. Step 1: application of a skin expander in the breast region in order to re-create the mammary space. Step 2: microsurgical transfer of the de-epithelialized flap, rolled up to create a pseudo-mammary gland, then insertion into the expanded mammary space. Step 3: reconstruction of the areola-nipple complex from the contralateral side and restoration of breast symmetry. The results of breast reconstruction according to this technique were evaluated in a series of 14 cases operated between 1987 and 1991, while the sequelae of the gluteal donor site were evaluated on a series of 65 free inferior gluteal flaps performed between 1977 and 1991. The advantages of this procedure are the natural curvature and softness of the reconstructed breast, the moderate sequelae at the donor site, leaving a scar dissimulated in the gluteal fold. This technique was compared with other reconstruction techniques: microsurgical procedures (non de-epithelialized inferior gluteal flap, superior gluteal flap, lateral mammary flap, etc.) and conventional procedures (breast expansion+prosthesis, latissimus dorsi flap, rectus abdominis flap). In conclusion, another technique is described, which appears to offer the advantages of the de-epithelialized inferior gluteal flap without the disadvantage of microsurgical transfer: reconstruction with a de-epithelialized rectus abdominis pedicle flap after expansion of the mammary space.