A novel surgical technique of use of the Goligher self-retaining retractor for microvascular anastomosis in reconstruction after minimally invasive mastectomy

In recent years, minimally invasive breast surgery (MIBS) has revolutionized breast cancer treatment, allowing for preservation of aesthetic outcomes while ensuring oncological safety. However, this has created a new challenge in maintaining optimal visualization and dexterity during microvascular anastomosis which is critical for successful autologous tissue reconstruction. Traditional retractors often limit maneuverability, potentially impacting the outcomes of anastomotic procedures. We describe a novel use of the Goligher self-retaining retractor in microvascular anastomosis through an inframammary fold (IMF) incision in 6 breast cancer patients who underwent endoscopic total mastectomy (ETM) with free abdominal-based flap reconstruction. After the ETM is performed via an IMF incision, the Goligher retractor is assembled to retract the tissues for optimal visualisation and exposure for microvascular anastomosis. The average ischaemic time was 37.3 minutes (range, 22-50 minutes). One case required re-exploration, no flap failure occurred and no nipple/skin ischaemia/necrosis occurred. Our surgeons reported enhanced visibility, leading to more precise suturing and reduced operative times. This may correlate with a lower incidence of complications and favorable aesthetic outcomes. Overall, the Goligher retractor presents an excellent adjunct in the field of minimally invasive mastectomy reconstruction and its integration into surgical practice may contribute to improved surgical outcomes.