Autologous breast reconstruction with tissue from the medial thigh

摘要

Today flaps from the medial or dorsal thigh (TMG, TUG, PAP) are an established and safe standard procedure for the autologous breast reconstruction of small and medium size breasts. 98 Patients (mean age 46 years) were treated with 116 flaps due to breast cancer, genetic predisposition, capsular fibrosis and asymmetry. The transverse skin island of theses flaps on the medio-dorsal thigh has a secure blood supply from perforators of the gracilis muscle and the profound femoral artery. Recipient vessels were the internal mammary artery and vein (IMA/V) and their intercostal perforators (IMAP) which were used in 37% of cases. 113 Flaps healed primarily (98%). 71 breast reconstructions were performed after breast cancer (49 immediate and 22 secondary), 26 because of genetic predisposition, 10 for capsular fibrosis and 9 due to asymmetry of the breasts. The mean follow up was 18 month. The mean weight of the flaps was 234 g. Unilateral reconstruction was performed in an average time of 201 minutes, bilateral reconstruction in 341 minutes. The mean hospital stay was 6.4 days. 12 patients showed a slowed wound healing at the donor site which needed revision surgery in 3 cases. 6 patients showed seromas at the donor site which healed after puncture. Load dependent sternal pain and tight feeling of the thighs were observed after surgery in some patients but disappeared after 8 weeks. Paraesthesia was observed at the medio-dorsal thighs but patients described it as not disturbing. A correction of symmetry after unilateral flap harvest was not necessary. The constant vascular anatomy and the possibility to operate in two teams from the beginning of the operation due to no intraoperative relocation of the patient, makes the flaps from the medial thigh a safe and fast procedure for small or medium sized autologous breast reconstruction. The rib sparing approach by using intercostal perforator vessels leads to a decreased recipient site morbidity of the patients and a short recovery period.