[Breast reconstruction with inferior transverse abdominal flap after mastectomy for cancer]

Breast reconstruction with an inferior transversal abdominal flap provides good quality cosmetic results. Indications for this flap technique are presently limited because of the frequency of complications in early series. The aim of this study was to evaluate the different parameters which could reduce the number of complications. From January 1989 to July 1991, 25 patients were treated with this method at the René-Gauducheau Centre. All patients were treated with the same surgical technique. Based on the complications observed in this series and a review of the literature, we were able to determine those factors which could limit the number of complications. Preoperative patient selection defined a population at risk of vascular complications. This population corresponded to a good indication for double pediculated flaps. Global flap removal, the muscle and the anterior sheath of the aponevrose together, and maintaining the patient in a sitting position for five days after the operation helped reduce the frequency of complications. Folding the abdominal wall with a nonabsorbable sheath appeared to be a simple and reliable method of reducing the number of abdominal complications. The double pediculated flap was indicated in all cases at risk of partial necrosis or when a large volume was necessary to avoid asymmetry. Using this type of management, breast reconstruction with inferior transversal abdominal flap is the first intention technique used at the René-Gauducheau Centre in Nantes.