Semin Plast Surg 2002; 16(1): 093-100
DOI: 10.1055/s-2002-22684
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Future of Supramicrosurgery as it Relates to Breast Reconstruction: Free Paraumbilical Perforator Adiposal Flap

Isao Koshima, Yuzaburo Nanba, Yoshio Takahashi, Akihiko Tsukino, Koji Kishimoto
  • Department of Plastic and Reconstructive Surgery, Okayama University Medical School, Okayama, Japan
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Publication History

Publication Date:
22 March 2002 (online)


Pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps have been generally used for bilataral breast losses. The major disadvantages of this method are the total or subtotal loss of the rectus abdominis muscles and various resulting postoperative complications, such as abdominal bulging and lumbar pain. With the recent development of perforator flaps and supermicrosurgery with anastomosis of 0.5-mm caliber vessels, these serious complications can be overcome with a paraumbilical perforator adiposal flap with only perforators without the deep inferior epigastric artery and the rectus abdominis muscle. This article describes the successful use of paraumbilical adiposal flap for patients with breast loss and facial contour deformities without secondary debulking for recontouring. The advantages of this method are one-stage augmentation with minimal donor site morbidity resulting in minimum invasive surgery with minimum incision.