Repurposing the Pedicled Posterior Arm Flap for Autologous Breast Reconstruction

The posterior arm flap (PAF) is a fasciocutaneous flap that has been used in axillary reconstruction; however, there is a paucity of literature to support its use in postmastectomy reconstruction in patients who no longer have more traditional autologous breast reconstruction options available. Herein, we present an alternative approach for autologous breast reconstruction using a modified pedicled PAF. Our patient presented to the clinic requesting implant removal and autologous reconstruction due to persistent pain and discomfort. Her history of a right-sided transverse rectus abdominis myocutaneous flap, extended axillary scar violating latissimus dorsi muscle, and liposuction to bilateral thighs precluded use of the deep inferior epigastric perforator, latissimus dorsi, or profunda artery perforator flaps. She was noted to have excess tissue in the upper extremities and, thus, the decision was made to perform a pedicled PAF for reconstruction. An adipocutaneous flap was raised from the bilateral posteromedial arms based on perforators from the brachial artery. The implant and capsule were excised using the previous mastectomy incisions. The PAF was tunneled through the axilla and inset to fill the breast mound. The patient tolerated the procedure well and was discharged home on postoperative day three. At her 1-year follow-up, the patient remains pleased with her results and has had no postoperative complications. The PAF is a viable option in patients who desire small-to-moderate sized breasts and in those unable to undergo prolonged free flap reconstruction due to comorbidities or inadequate donor sites.