Fold Flaps to the Rescue in Postmastectomy Breast Reconstruction

Ischemic complications following postmastectomy breast reconstruction are not uncommon and can lead to reconstructive failure, especially with implant reconstruction. The authors propose a simple local flap for management of such complications. This flap is easily raised from the upper abdomen or lateral chest as a medially or laterally based fasciocutaneous flap, and the donor site is hidden in the inframammary or lateral mammary fold. The authors present a case series of these "fold flaps" that were used to manage complications following implant-based breast reconstruction. All patients between 2007 and 2021 who underwent a fold flap for breast reconstruction salvage were queried from a prospectively maintained database. Demographic variables, clinical factors, and surgical details were analyzed. Outcomes assessed included complications, appropriate wound healing, and reconstructive salvage. Fourteen patients underwent thoracoepigastric or thoracoabdominal fold flaps following breast reconstruction for soft-tissue coverage with an underlying prosthesis. The mean age was 54 years, mean body mass index was 30 kg/m 2 , and mean follow-up duration was 18.5 months. Fold flap indications included mastectomy skin flap necrosis ( n = 9), infection ( n = 4), and chronic seroma ( n = 1). Eleven reconstructions (79%) were salvaged and three (21%) required eventual prosthesis explantation secondary to infection or delayed wound healing. Fold flaps are a reliable option for managing ischemic complications following postmastectomy breast reconstruction. The benefits include improved soft-tissue coverage with a high salvage rate. These flaps are simple to raise, and their donor site is concealed within the folds. Furthermore, they provide a reliable early option to manage complications and potentially prevent reconstructive failure.

Therapeutic, IV.