Immediate reconstruction using a modified inframammary adipofascial flap after partial mastectomy

Abstract

Breast conservative therapy (BCT) as treatment for early breast cancer usually ensures local control and acceptable cosmetic results. We describe a new technique of using an inframammary adipofascial flap to reconstruct defects caused by lower-pole partial mastectomy, which achieved excellent results (Kijima et al. in Am J Surg 193:789-91 (1); Sakai et al. in Ann Plast Surg 29(2):173-7, 2; Ogawa Am J Surg 193:514-8, 3). We developed this procedure as an oncoplastic technique for a Japanese woman with a similar defect without ptosis. After partial mastectomy, the superior half of the flap is harvested via an initial incision along the inframammary line, and the inferior half is harvested via an additional incision along the caudal edge of the flap, to produce a crescent of de-epithelialized skin. A tongue-shaped flap containing the crescent of de-epithelialized skin, subcutaneous fat, and the fascia of the vertical rectus abdominis muscle is then rotated upwards, gathered, and inserted into the breast defect.

Fig. 1

Case 1: preoperative markings of the area to be resected in a 53-year-old patient with a T1 tumor in the lower-outer quadrant of the left breast. a A purple spot formed after core needle biopsy (CNB). Her breasts were not ptotic. b, c The cancer lesion and the scar in the 6 o’clock position left by the CNB are circled in red. The incision line is drawn in red along the inframammary line

Fig. 2

Operative findings. a A tongue-shaped adipofascial flap, 10 cm in length, was drawn as a black dotted line. A crescent of skin was de-epithelialized. b The flap was harvested via an inframammary incision line and a caudal window. c The de-epithelialized skin was harvested together with the inframammary flap. d The tissue was rolled up towards the cranial side

Fig. 3

Scheme of the modified inframammary adipofascial flap. a A crescent area on the cranial edge of the flap was de-epithelialized. b A flap containing the anterior rectus sheath of the abdominis muscle was harvested via two incisions. c The flap was placed into the cranial breast cavity and gathered. Anchor sutures were added to the donor site

Fig. 4

Photograph taken 2 years after the procedure. Although, there was a hypertrophic scar from the CNB scar, symmetry was clearly achieved