Microvascular modifications to optimize the transverse upper gracilis flap for breast reconstruction

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• The transverse upper gracilis flap is a viable option for breast reconstruction but has limitations such as modest volume and short pedicle.
• These limitations often necessitate bilateral flaps for unilateral reconstruction, sacrifice of thoracodorsal vessels, or the use of vein grafts.

Purpose of the Study:

• To present modified microvascular techniques for transverse upper gracilis flap breast reconstruction.
• To overcome the limitations of modest volume and short pedicle associated with this flap.

Main Methods:

• Description of novel maneuvers including costal cartilage excision, nontraditional internal mammary arterial anastomoses, and adductor branch utilization for flap-to-flap anastomoses.
• Case series of 30 transverse upper gracilis flaps for 20 breasts in 18 patients.
• Anatomical study of gracilis pedicle branching patterns in 33 cadaveric specimens.

Main Results:

• All 30 flaps survived, with 75% of reconstructions being unilateral.
• 67% of unilateral reconstructions utilized two flaps for a single breast.
• Mean reconstructed breast volume was 360.9 g; successful double flap reconstructions were achieved in 10 breasts using various anastomotic strategies.

Conclusions:

• A new classification system for gracilis flap branching patterns was defined.
• Flap-to-flap anastomoses are feasible in 75% of patients, with alternative strategies available for the remaining 25% to achieve successful double flap reconstructions.