J reconstr Microsurg
DOI: 10.1055/s-0037-1607363
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Defining the Role of Free Flaps in Partial Breast Reconstruction

Mark L. Smith1, Bianca J. Molina2, Erez Dayan3, Eric M. Jablonka4, Michelle Okwali2, Julie N. Kim2, Joseph H. Dayan5
  • 1Division of Plastic Surgery, Northwell Health System, Lake Success, New York
  • 2Division of Plastic Surgery, Mount Sinai Beth Israel, New York, New York
  • 3Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
  • 4Division of Plastic Surgery, Mount Sinai Hospital, New York, New York
  • 5Division of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
Further Information

Publication History

05 March 2017

14 September 2017

Publication Date:
12 November 2017 (eFirst)

Abstract

Background Free flaps have a well-established role in breast reconstruction after mastectomy; however, their role in partial breast reconstruction remains poorly defined. We reviewed our experience with partial breast reconstruction to better understand indications for free tissue transfer.

Methods A retrospective review was performed of all patients undergoing partial breast reconstruction at our center between February 2009 and October 2015. We evaluated the characteristics of patients who underwent volume displacement procedures versus volume replacement procedures and free versus pedicled flap reconstruction.

Results There were 78 partial breast reconstructions, with 52 reductions/tissue rearrangements (displacement group) and 26 flaps (replacement group). Bra cup size and body mass index (BMI) were significantly smaller in the replacement group. Fifteen pedicled and 11 free flaps were performed. Most pedicled flaps (80.0%) were used for lateral or upper pole defects. Most free flaps (72.7%) were used for medial and inferior defects or when there was inadequate donor tissue for a pedicled flap. Complications included hematoma, cellulitis, and one aborted pedicled flap.

Conclusion Free and pedicled flaps are useful for partial breast reconstruction, particularly in breast cancer patients with small breasts undergoing breast-conserving treatment (BCT). Flap selection depends on defect size, location, and donor tissue availability. Medial defects are difficult to reconstruct using pedicled flaps due to arc of rotation and intervening breast tissue. Free tissue transfer can overcome these obstacles. Confirming negative margins before flap reconstruction ensures harvest of adequate volume and avoids later re-operation. Judicious use of free flaps for oncoplastic reconstruction expands the possibility for breast conservation.