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Double-pedicle unaffected split-breast flap for unilateral breast reconstruction
Toshihiko Satake1, Mayu Muto2, Maki Okamoto1
1Department of Plastic, Reconstructive and Aesthetic Surgery, Toyama University Hospital, Toyama, Japan.
Microsurgery
|January 5, 2022
Summary
Autologous small-breast reconstruction using the unaffected split-breast (USB) flap offers a viable option for breast cancer patients. This technique, combined with contralateral breast reduction, achieved high aesthetic satisfaction and no recurrence in a 14-patient study.
Area of Science:
- Plastic Surgery
- Oncology
- Reconstructive Surgery
Background:
- Unilateral breast reconstruction in breast cancer patients with contralateral hypertrophy and ptosis presents unique challenges.
- Autologous reconstruction using contralateral breast tissue is a recognized approach.
- The unaffected split-breast (USB) flap offers a potential solution for simultaneous reconstruction and contralateral reduction.
Purpose of the Study:
- To evaluate the efficacy of the double-pedicle unaffected split-breast (USB) flap for unilateral breast reconstruction.
- To assess the outcomes of combining USB flap reconstruction with contralateral transverse scar reduction mammoplasty.
- To determine the safety and aesthetic results of this combined surgical approach.
Main Methods:
- A cohort of 14 patients underwent unilateral breast reconstruction using the USB flap between 2003 and 2020.
- The USB flap was harvested from the central half of the unaffected breast, incorporating internal mammary perforator (IMAP) and lateral thoracic vessel (LTA/V) supply.
- Flap perfusion was assessed using indocyanine green (ICG) angiography, followed by flap transfer and anastomosis. Contralateral reduction mammoplasty was performed using remaining breast tissue.
Main Results:
- All 14 flaps and reduced breasts survived, with minimal complications (one hematoma, one hypertrophic scar).
- Indocyanine green (ICG) angiography indicated variable perfusion in the distal flap, ranging from 22.0% to 48.5%.
- High aesthetic outcomes were reported, with 78.6% of patients rating their results as "good" or "excellent" after a mean follow-up of 53.8 months. No recurrence or second primary breast cancer was observed.
Conclusions:
- The unaffected split-breast (USB) flap combined with contralateral reduction mammoplasty is an effective and safe technique for unilateral breast reconstruction.
- This method provides satisfactory aesthetic results and oncological safety for selected breast cancer patients.
- The USB flap technique is a valuable option for patients with a hypertrophic and ptotic contralateral breast.
