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Updated: Jun 5, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Technical and Analytical Approach for Breast Reconstruction With IMAP Propeller Flap
Antonio Spaggiari1, Wayne A Morrison2, Caterina Marra1
1From the Plastic and Reconstructive Surgery Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
This study revisits the breast-sharing technique for breast reconstruction after mastectomy. Combining computed tomography angiography (angio-CT) and indocyanine green (ICG) imaging improves vascular predictability, making the internal mammary artery perforator (IMAP) flap a viable option for select patients.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Medical Imaging
Background:
- The breast-sharing technique utilizes lower quadrants from contralateral reduction mammoplasty for post-mastectomy breast reconstruction.
- This technique has historically faced challenges with vascular predictability.
Purpose of the Study:
- To re-evaluate the breast-sharing technique for breast reconstruction.
- To enhance vascular predictability using preoperative computed tomography angiography (angio-CT) and intraoperative indocyanine green (ICG) imaging.
Main Methods:
- Twenty-six patients underwent preoperative angio-CT to identify internal mammary artery perforators (IMAP).
- A Wise skin-pattern reduction facilitated elevation of a flap based on the IMAP.
- Intraoperative ICG confirmed flap perfusion.
Main Results:
- Sixteen breast-sharing flaps were successfully performed after excluding 8 patients.
- Two cases experienced distal flap venous compromise, and one had an infection.
- No donor site healing issues were noted; 2 patients required areola repositioning.
Conclusions:
- The study revitalizes the breast-sharing flap by addressing weaknesses through advanced imaging.
- The IMAP propeller flap, enhanced by angio-CT and ICG, offers a simpler, safer alternative to free flaps for suitable candidates.
