Application of a rhomboid flap for the coverage of defects after malignant breast tumor resection: A case report

Abstract

Resection for locally advanced breast cancer (LABC) or malignant phyllodes tumors may cause a large skin defect with bone exposure. Although skin grafts are frequently used to cover such defects, they can result in poor cosmetic outcomes and graft acceptance is dependent upon the condition of the recipient site. To overcome the limitations of skin grafts, various flaps have been developed to cover such defects. The present study used a rhomboid flap for the coverage of skin defects after mastectomy and breast-conservative surgery (BCS). A total of 11 patients with malignant breast cancer underwent reconstructive surgery using the rhomboid flap between September 2011 and December 2013 (mastectomy, 9 patients; BCS, 2 patients). Skin resection size, axillary lymph node dissection, bone exposure, length of surgery, wound complications and whether preoperative/postoperative adjuvant therapy was received were analyzed. The maximum size of skin defect covered with the rhomboid flap in the present study was 20×20 cm. There were no major wound complications and all patients underwent postoperative adjuvant therapy on schedule. During BCS, a portion of the flap was used for augmentation of the breast, in addition to coverage of the skin defect, which resulted in good cosmetic outcomes. The rhomboid flap can be quickly and easily fashioned, and it does not require any special instruments.

Keywords: breast cancer; malignant phyllodes tumor; reconstructive surgery; rhomboid flap; surgical flap.

Figure 1.

Schema of rhomboid flap designs for coverage of (A) mastectomy and (B) BCS defects.

Figure 2.

Preoperative and postoperative views of case 1 (patient 7). (A) Preoperatively, the tumor had a maximum diameter of 30 cm with a continuously bleeding skin ulcer (A). (B) The skin defect after tumor resection, in which the costal bones were exposed. (C) The rhomboid flap fashioned after transposition. (D) The outcome 8 months after surgery.

Figure 3.

Preoperative and postoperative views of case 2 (patient 9). (A) Preoperative view of the tumor and resection markings. The nipple-areolar complex of the left breast was raised compared with that of the right breast due to the tumor. (B) The skin defect after tumor resection. (C and D) A total of 8 months after surgery the breasts were almost symmetrical.