Breast Reconstruction with a Lateral Breast Free Flap: A New Application of Breast-sharing

Abstract

Breast reconstruction using contralateral autologous tissue, also known as breast sharing, is a viable option previously described in the literature, whereby flaps based on perforators of the internal mammary artery (internal mammary artery pedicle) are used. We report a postoncological breast reconstruction case using a microvascular flap taken from the lateral pole of the contralateral breast. We highlight the importance of preserving the medial pole of the donor breast for improving cosmesis, avoiding symmastia, and preserving the intermammary sulcus, as a difference with flaps based on the internal mammary artery pedicle flaps. Breast sensation could be recovered by neurotization of the lateral intercostal nerve, which may be included in the contralateral breast flap to be transferred. Contralateral breast free flaps could be an alternative to reconstruct the breast in selected patients. Oncological risk factors are discussed. Advances in genetic testing and tumor cell biology could help us to select the accurate candidates for this reconstructive technique.

Fig. 1.

Postoperative of right mastectomy and expander reconstruction, there is cephalic displacement of the expander and left mammary hypertrophy. Design of superomedial pedicle left reduction mammoplasty. Striped area corresponds to the skin and breast tissue discarded in a breast reduction and to be used as the breast free flap to be transferred.

Fig. 2.

Intraoperative flap dissection with the nipple and the areola in a superior medial dermoglandular pedicle, and the inferior lateral flap to be transferred based on 3 available pedicles: perforators of anterior thoracodorsal artery, serratus anterior artery perforator, and lateral thoracic artery.

Fig. 3.

Postoperative result after tattoo nipple and areola reconstruction. A, Frontal view. B, Oblique view.