Reconstruction of Large Post-Mastectomy Defect: a Plastic Surgeon’s Dilemma

Abstract

Breast cancer is the most common cause of death due to malignancy among women worldwide. The goal of breast reconstruction post-mastectomy is to improve the quality of life whilst not increasing health risk. Reconstruction of a large-sized post-mastectomy defect with satisfactory outcome poses a challenge to the reconstructive surgeon. In advanced breast cancer, post-operative adjuvant chemotherapy and radiotherapy rates are also increasing. In these patients, plastic surgeons are presented with the substantial challenge to cover an extensive skin and soft tissue defect after mastectomy with autologous tissue. Such extensive defects are difficult to reconstruct with available flaps. The decision regarding the most appropriate reconstruction technique and whether to perform an immediate or delayed reconstruction should take into consideration the patient’s preference, risk factors and physical characteristics. We present three cases of post-radical mastectomy with large chest wall defects, > 200 sq. cm in greatest dimensions, one of which had an exposed lung, where immediate reconstruction with microvascular free antero-lateral thigh flap was done. Recipient vessels were internal mammary vessels and cephalic vein in all the cases. Post-operatively, patients did well with limited donor-site morbidity. Hence, the antero-lateral thigh (ALT) flap can be considered as a good option for cases with large defects.