Limberg flap in mastectomy T-junction necrosis: an underutilised technique

The Wise-pattern skin-sparing mastectomy (SSM) is well known for its efficacy in large ptotic breasts, and its safety in facilitating immediate breast reconstruction. An unfortunate sequalae for all SSM techniques is mastectomy skin flap necrosis (MSFN) with a reported range of occurrence of 5%-30%. For the Wise pattern, the common area of wound dehiscence or necrosis is the T-junction. Different techniques have been described in the management of MSFN-ranging from primary closure to local and distant flaps. Full thickness MSFN results in wound breakdown and can expose a prosthesis, subsequently closure must be obtained with potential for the prosthesis to be explanted. To date, there has been no reports in the literature of the usage of a rhomboid flap in an SSM with immediate prepectoral implant. We discuss our experience in the usage of this local cosmetic flap to avoid prosthesis loss and have reviewed the literature regarding MSFN, the application of the rhomboid (Limberg) flap in breast surgery and its applicability in MSFN to preserve underlying prosthesis.