Current status of autologous breast reconstruction in Argentina.

Abstract

Although the most common procedure for breast reconstruction in Argentina is tissue expansion and implant devices, autologous tissue is frequently utilized. Deep inferior epigastric artery perforator flap (DIEP) is the gold standard for autologous breast reconstruction and, whenever possible, it is the first option. However, there are clinical or other circumstances, when a local or vicinity flaps for autologous reconstruction is preferred, even if exists a surgical and hospital facility for doing microsurgical procedures. The purpose of this manuscript is to describe our experience with the use of local and vicinity flaps for volume and surface replacement in different requirements-autologous breast reconstructions post oncologic resections, volume replacement in weight loss patients and implant-explantation cases. We have utilized the modification of latissimus dorsi musculocutaneous flap (LD) described by Hammond with excellent results and high patient satisfaction. Thoraco-dorsal artery perforator flap is indicated on skin sparing mastectomies (SSMs), immediate reconstruction of the nipple areolar complex and simultaneous coverage of an implant or tissue expander, in irradiated or to be irradiated patients. Lateral intercostal artery perforator (LICAP) flap has gained popularity because the unique position of the perforator at the lower lateral corner of the breast. It allows harvesting immediate vicinity tissue and easy rotation to the breast mound. We have used a modification towards the lateral thoracic wall of the anterior intercostal artery perforator flap for volume reconstruction after implant explantation.in patients who required volume preservation. Medial intercostal artery perforator flap is advantageous whenever the sub-mammary tissue can be used deepithelialized for volume reconstruction with a medial base. The same submammary area harvested as a medially based flap can be irrigated by the LICAP as a reverse LICAP flap that might be designed toward any direction from the piercing point of its perforator. The rest of the donor areas described for breast autologous reconstruction are rarely reported. When surgical facilities and adequate surgical teams are available, the lower abdominal wall is the main donor area, and DIEP, the most common technique utilized.