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Flaps

Authoring team

A number of myocutaneous flaps have been used in the reconstruction of the breast but only two are used on a relatively common basis:

  • pedicled latissimus dorsi:
    • advantages include ease of creation and reasonable recreation of bulk and contour at the time of mastectomy
    • disadvantages include large scar on the back and change of contour under the arm particularly with the arm elevated
  • transverse rectus abdominis:
    • pedicled: the contralateral half of the rectus abdominis muscle is divided at its inferior end and swung superiorly on the superior epigastric artery
    • free: the rectus abdominis muscle is harvested and the inferior epigastric vessels are anastomosed with the thoracodorsal vessels within the axilla
    • better cosmetic result
    • disadvantages include:
      • need for microscopic and expertise during free flap transfer
      • contraindicated in patients with lower abdominal scars secondary to previous operations

Flaps may be combined with other reconstructive procedures e.g. tissue expansion.


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