The longitudinal gracilis myocutaneous flap: broadening options in breast reconstruction

Many patients who present for autogenous breast reconstruction are not suitable candidates for abdominal wall flaps, either because of previous abdominal surgery (most commonly transverse rectus abdominis myocutaneous flap for prior breast reconstruction) or because of the lack of enough adipose tissue. Another donor site option is the medial thigh that has more recently been recognized as a source of tissue for breast reconstruction. Prior reports have described the harvest of a gracilis myocutaneous flap through a transverse incision. From August 2004 to April 2007, 12 patients underwent autogenous breast reconstruction of 15 breasts with the longitudinal gracilis myocutaneous microvascular flap. The patients' ages ranged from 41 to 60 years (average, 48 years). In all patients the longitudinal gracilis flap was chosen because of a desire for autogenous reconstruction and a lack of available abdominal wall tissue. Mean follow-up of the 12 patients was 16.8 months (range, 5-36 months). There was no microvascular thrombosis or free-flap failure in this series. Donor sites were well tolerated by all patients. Three patients underwent suction-assisted lipectomy of 5 donor site areas to improve contour and/or symmetry. The longitudinal gracilis myocutaneous flap is a useful alternative for breast reconstruction in properly selected patients.