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Review
. 2015 Apr;4(2):145-53.
doi: 10.3978/j.issn.2227-684X.2015.02.04.

Achieving ideal donor site aesthetics with autologous breast reconstruction

Maurice Y Nahabedian  1
Affiliations
Review

Achieving ideal donor site aesthetics with autologous breast reconstruction

Maurice Y Nahabedian. Gland Surg. 2015 Apr.

Abstract

The appearance of the donor site following breast reconstruction with abdominal flaps has become an important topic for study. Given the variety of flaps that are derived from the abdomen, decisions are often based on how much muscle and fascia will be harvested. Comparisons between muscle sparing and non-muscle sparing techniques have been performed with outcomes related to function and contour. Closure techniques will vary and include primary fascial closure, mesh reinforcement and additional fascial plication all of which can produce natural and sometimes improved abdominal contours. Proper patient selection however is important. This manuscript will describe various techniques in order to achieve ideal abdominal contour following autologous reconstruction.

Keywords: Breast reconstruction; aesthetics; donor site.

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Figures

Figure 1
Figure 1
Lateral view demonstrating a moderate pannus due to subcutaneous fat.
Figure 2
Figure 2
Lateral view demonstrating a convex abdominal wall due to intraabdominal fat.
Figure 3
Figure 3
Intraoperative photograph of an MS-3 bilateral DIEP flap. DIEP, deep inferior epigastric perforator.
Figure 4
Figure 4
Intraoperative photograph of an MS-1 bilateral free TRAM flap. TRAM, transverse rectus abdominis musculocutaneous.
Figure 5
Figure 5
Preoperative markings of an abdominal flap.
Figure 6
Figure 6
Intraoperative photograph demonstrating the vascularity of the anterior rectus sheath.
Figure 7
Figure 7
Intraoperative photograph demonstrating closure of the medial and lateral segments of the rectus abdominis muscle.
Figure 8
Figure 8
Fascial closure and plication following an MS-3 flap harvest.
Figure 9
Figure 9
A biologic mesh is placed as an inlay graft.
Figure 10
Figure 10
A synthetic mesh is used for onlay reinforcement.
Figure 11
Figure 11
Preoperative image prior to abdominal flaps.
Figure 12
Figure 12
Postoperative image following bilateral breast reconstruction with DIEP flaps. DIEP, deep inferior epigastric perforator.
Figure 13
Figure 13
Preoperative image prior to mastectomy and bilateral free TRAM. TRAM, transverse rectus abdominis musculocutaneous.
Figure 14
Figure 14
Intraoperative image demonstrating a rectus diastasis.
Figure 15
Figure 15
Anterior view following bilateral fascial closure. There is significant distortion superiorly and laterally.
Figure 16
Figure 16
Lateral view demonstrating severe distortion prior to fascial plication.
Figure 17
Figure 17
Anterior view following superior and lateral plication demonstrating improved contour.
Figure 18
Figure 18
Lateral view demonstrating an improvement in abdominal contour.
Figure 19
Figure 19
Postoperative view demonstrating normal abdominal contour following bilateral free TRAM flaps. TRAM, transverse rectus abdominis musculocutaneous.
See this image and copyright information in PMC

References

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