Oncoplastic technique combining an adipofascial flap with an extended glandular flap for the breast-conserving reconstruction of small dense breasts

Abstract

We introduce a method combining two oncoplastic techniques for breast-conserving reconstruction. The procedure is as follows: first, an extended glandular flap is made by undermining the breast from both the skin and the pectoralis fascia to the upper edge of the breast at the subclavicular area. After modeling the breast mound with the extended glandular flap, an inframammary adipofascial flap is made. The flap is reflected back to the breast area remodeled using the extended glandular flap. After reshaping the breast, the inframammary line is then re-shaped. This method is indicated for patients with breast cancer in the outer portion of the breast, who have small dense breasts, and have undergone a large excision of about 40% of their breast volume. We treated four patients, all of whom had either excellent or good cosmetic results with no fat necrosis.

Keywords: Mammaplasty; Segmental mastectomy; Surgical procedures.

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, as well as the inframammary groove, the area of the adipofascial flap, and the location of perforators (x mark).

Figure 2

The extended glandular flap. The extended glandular flap is made by freeing the breast from both the skin and the pectoralis fascia. The flap is moved into the defect in the direction of arrows, and the breast mound is remodeled.

Figure 3

The inframammary adipofascial flap. The inframammary adipofascial flap is reflected back to the breast area (arrow) that was remodeled by using the extended glandular flap.

Figure 4

Checking the shape of the breast. The nipple position is set at the position that had been marked before surgery with the patient in the standing position while applying pressure from the upper side (arrow).

Figure 5

Photographs of case 1, showing the good cosmetic results. (A, B) Preoperative photographs: (A) frontal view, (B) oblique view. (C, D) Postoperative photographs taken 6.6 years after the operation: (C) frontal view, (D) oblique view.

Figure 6

Photographs of case 2, showing the excellent cosmetic results. (A, B) Preoperative photographs: (A) frontal view, (B) oblique view. (C, D) Postoperative photographs taken 3.1 years after the operation: (C) frontal view, (D) oblique view.

Figure 7

Photographs of case 3, showing the excellent cosmetic results. (A, B) Preoperative photographs: (A) frontal view, (B) oblique view. (C, D) Postoperative photographs taken 2.4 years after the operation: (C) frontal view, (D) oblique view.

Figure 8

Photographs of case 4, showing the good cosmetic results. (A, B) Preoperative photographs: (A) frontal view, (B) oblique view. (C, D) Postoperative photographs taken 1.3 years after the operation: (C) frontal view, (D) oblique view.