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Case Reports
. 2024 Dec:125:110567.
doi: 10.1016/j.ijscr.2024.110567. Epub 2024 Nov 9.

Internal mammary artery perforator-based plug flap

Nello Pirozzi  1 , Nicola Rocco  2 , Maurizio Bruno Nava  3 , Maíra Teixeira Dória  4 , Camilla Victoria Weigert  4 , Cícero de Andrade Urban  4
Affiliations
Case Reports

Internal mammary artery perforator-based plug flap

Nello Pirozzi et al. Int J Surg Case Rep. 2024 Dec.

Abstract

Introduction: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fascio-cutaneous pedicled chest wall perforator flaps or local perforator flaps (CWPF).

Case presentation: We present a case of reconstruction with internal mammary artery perforator (IMAP)-based plug flap to fill the infero-medial defect caused by a tumor close to skin, with visible retraction.

Clinical discussion: A 52 years old woman, with an extensive palpable mass (3 cm) in the lower medial quadrant of the right breast, the tumor was close to skin, with visible retraction. The patient has small and round breasts, without ptosis.

Conclusion: In this situation and when there is skin that needs to be removed, reconstruction can be done with a pedicle flap skin paddle; the IMAP flap is an ideal donor site in these cases. It is a safe flap with good vascularization and offers a great cosmetic result.

Keywords: Breast surgery; Case report; Oncoplastic surgery; Perforator flap; Plastic surgery.

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Conflict of interest statement

Conflict of interest statement None declared.

Figures

Fig. 1
Fig. 1
a,b: The patient has small and round breasts, without ptosis. The tumor was close to skin, with visible retraction.
Fig. 2
Fig. 2
a,b: Magnetic resonance of the breast showing the mass in the lower medial quadrant of the right breast.
Fig. 3
Fig. 3
a: Anatomy of perforating branches of the anterior thorax wall showing the medial brach of the internal mammary artery (taken from Acea Nebril, B. et al. (2016) ‘Rotational flaps in oncologic breast surgery. anatomical and technical considerations’, Cirugía Española (English Edition), 94(7), pp. 372–37). b: Preoperative planning for the plug flap technique using the inferior branch of the internal mammary artery as its base.
Fig. 4
Fig. 4
a,b: Skin defect measuring 3.5 cm and internally measuring approximately 5 cm in diameter. Intraoperative assessment of the rotation arc and planning of the plug flap area.
Fig. 5
Fig. 5
Delimitation of the skin flap and de-epithelialization.
Fig. 6
Fig. 6
a,b,c: Preparation and rotation of the plug flap based on the inferior branch of the internal mammary artery.
Fig. 7
Fig. 7
Result one week after surgery.
See this image and copyright information in PMC

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