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. 2011:2011:359842.
doi: 10.1155/2011/359842. Epub 2011 Sep 20.

Breast-volume displacement using an extended glandular flap for small dense breasts

Tomoko Ogawa  1 , Noriko Hanamura, Masako Yamashita, Hiroko Kimura, Yumi Kashikura
Affiliations

Breast-volume displacement using an extended glandular flap for small dense breasts

Tomoko Ogawa et al. Plast Surg Int. 2011.

Abstract

We defined the glandular flap including fat in the subclavicular area as an extended glandular flap, which has been used for breast-conserving reconstruction in the upper portion of the breast. Indication. The excision volume was 20% to 40% of the breast volume, and the breast density was dense. Surgical Technique. The upper edge of the breast at the subclavicular area was drawn in the standing position before surgery. After partial mastectomy, an extended glandular flap was made by freeing the breast from both the skin and the pectoralis fascia up to the preoperative marking in the subclavicular area. It is important to keep the perforators of the internal mammary artery and/or the branches of the lateral thoracic artery intact while making the flap. Results. Seventeen patients underwent remodeling using an extended glandular flap. The cosmetic results at 1 year after the operation: excellent in 11, good in 1, fair in 3, and poor in 2. All cases of unacceptable outcome except one were cases with complications, and more than 30% resection of moderate or large size breasts did not obtain an excellent result for long-term followup. Conclusion. This technique is useful for performing the breast-conserving reconstruction of small dense breasts.

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Figures

Figure 1
Figure 1
The design before the operation. Marking the partial resection area, the upper edge of the breast at the subclavicular area and the position of the nipple in the standing position, and the location of perforators from the internal mammary artery. (a) Supine position. (b) Oblique view in the standing position.
Figure 2
Figure 2
The extended glandular flap.
Figure 3
Figure 3
Remodeling the breast using the extended glandular flap. The nipple position is set at the position that had been marked before surgery in the standing position while applying pressure from the upper side.
Figure 4
Figure 4
The patient of extended glandular flap. (a) Preoperative photograph. (b) Postoperative photograph at 1month after the operation.
Figure 5
Figure 5
A case with excellent cosmetic results. The tumor location was in the upper outer quadrant in this case. She experienced postoperative bleeding and had surgery again for bleeding and hematoma evacuation. (a) Preoperative design. (b) Photograph at 1 year 4 months after the operation.
Figure 6
Figure 6
A case with excellent cosmetic results. The tumor location was in the upper inner quadrant in this case. (a) Preoperative design. (b) Photograph at 1 year after operation.
Figure 7
Figure 7
A case with poor cosmetic results. The tumor location was in the upper inner quadrant in this case, however, the resection area is included the lower inner quadrant. She had partial fat necrosis of the extended glandular flap. (a) Preoperative design. (b) Photograph at 1 year 2 months after operation.
Figure 8
Figure 8
A case with poor cosmetic results. The patient experienced postoperative bleeding and hematoma. (a) Preoperative design. (b) Photograph at 1 year 6 months after operation.
See this image and copyright information in PMC

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