A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients
The ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this pr...
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| Veröffentlicht in: | Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2024-12, Vol.99, p.566-576 |
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| container_title | Journal of plastic, reconstructive & aesthetic surgery |
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| creator | Hamdi, Moustapha Waked, Karl De Baerdemaeker, Randy Szychta, Pawel Ramaut, Lisa Giunta, Gabriele Nistor, Alexandru |
| description | The ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety.
Between April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed.
In all the cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5.6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option.
The breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using indocyanine green imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low, and thus, the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction.
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| doi_str_mv | 10.1016/j.bjps.2024.09.087 |
| format | Article |
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Between April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed.
In all the cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5.6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option.
The breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using indocyanine green imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low, and thus, the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction.
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Between April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed.
In all the cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5.6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option.
The breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using indocyanine green imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low, and thus, the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction.
Level IV</description><subject>Adult</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast reconstruction</subject><subject>Female</subject><subject>Humans</subject><subject>IMAP flap</subject><subject>Mammaplasty - methods</subject><subject>Mastectomy - methods</subject><subject>Middle Aged</subject><subject>Patient Satisfaction</subject><subject>Pedicled flap</subject><subject>Perforator Flap</subject><subject>Postoperative Complications - epidemiology</subject><subject>Total breast reconstruction</subject><issn>1748-6815</issn><issn>1878-0539</issn><issn>1878-0539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO1DAQRSMEYh7wAyyQl2wSHNuxY8SmNYJhpEGwgLXlOJVpt5wHLmek_sv5JNwPYMfGj1Ld6-s6RfGmplVNa_l-V3W7BStGmaiormirnhWXdavakjZcP89nJdpStnVzUVwh7igVvBbNy-KC64YKxeRl8bQhXQSLieDWRj89kARuO_lfK5AVj_ctkAV67wL05O7r5jsZgl3IMEfSQ7D7XD07RHDzhCmuLvl5InbqSS6kaINNkFeC-3GEFP3Rd7TjaJeQhfsPZEOcRSAI0QMelfA4h_XoMw_HDLjGB--yy7-AfsqKAC7lDItNHqaEr4oXgw0Ir8_7dfHz86cfN1_K-2-3dzeb-9IxrlJphWhcy7SWchBONVxCx_LsmOSN0srRtu-E5rrTllk30EFwYIpzTeVgper5dfHu5LvEOWfBZEaPDkKwE8wrGl6zRrQyv5Bb2anVxRkxwmCW6Ecb96am5kDS7MyBpDmQNFSbTDKL3p79126E_q_kD7rc8PHUAPmXjx6iQZcn4DKqDCKZfvb_8_8Nr4a0nA</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Hamdi, Moustapha</creator><creator>Waked, Karl</creator><creator>De Baerdemaeker, Randy</creator><creator>Szychta, Pawel</creator><creator>Ramaut, Lisa</creator><creator>Giunta, Gabriele</creator><creator>Nistor, Alexandru</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7409-5626</orcidid><orcidid>https://orcid.org/0000-0001-6777-3866</orcidid><orcidid>https://orcid.org/0000-0001-6215-5858</orcidid></search><sort><creationdate>202412</creationdate><title>A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients</title><author>Hamdi, Moustapha ; Waked, Karl ; De Baerdemaeker, Randy ; Szychta, Pawel ; Ramaut, Lisa ; Giunta, Gabriele ; Nistor, Alexandru</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c237t-a445c829966f4c7536eb21872635797c08db4939b9a2acf0f43e2733906fa67d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast reconstruction</topic><topic>Female</topic><topic>Humans</topic><topic>IMAP flap</topic><topic>Mammaplasty - methods</topic><topic>Mastectomy - methods</topic><topic>Middle Aged</topic><topic>Patient Satisfaction</topic><topic>Pedicled flap</topic><topic>Perforator Flap</topic><topic>Postoperative Complications - epidemiology</topic><topic>Total breast reconstruction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hamdi, Moustapha</creatorcontrib><creatorcontrib>Waked, Karl</creatorcontrib><creatorcontrib>De Baerdemaeker, Randy</creatorcontrib><creatorcontrib>Szychta, Pawel</creatorcontrib><creatorcontrib>Ramaut, Lisa</creatorcontrib><creatorcontrib>Giunta, Gabriele</creatorcontrib><creatorcontrib>Nistor, Alexandru</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hamdi, Moustapha</au><au>Waked, Karl</au><au>De Baerdemaeker, Randy</au><au>Szychta, Pawel</au><au>Ramaut, Lisa</au><au>Giunta, Gabriele</au><au>Nistor, Alexandru</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients</atitle><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle><addtitle>J Plast Reconstr Aesthet Surg</addtitle><date>2024-12</date><risdate>2024</risdate><volume>99</volume><spage>566</spage><epage>576</epage><pages>566-576</pages><issn>1748-6815</issn><issn>1878-0539</issn><eissn>1878-0539</eissn><abstract>The ‘breast-sharing’ procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety.
Between April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed.
In all the cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5.6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option.
The breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using indocyanine green imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low, and thus, the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction.
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| identifier | ISSN: 1748-6815 |
| ispartof | Journal of plastic, reconstructive & aesthetic surgery, 2024-12, Vol.99, p.566-576 |
| issn | 1748-6815 1878-0539 1878-0539 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adult Breast Neoplasms - surgery Breast reconstruction Female Humans IMAP flap Mammaplasty - methods Mastectomy - methods Middle Aged Patient Satisfaction Pedicled flap Perforator Flap Postoperative Complications - epidemiology Total breast reconstruction |
| title | A breast sharing technique using the pedicled IMAP flap for delayed breast reconstruction and contralateral symmetrising mammaplasty: A case series and evolution of the surgical technique in selected patients |
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