Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction

Background:. When a single perforator flap does not provide adequate volume or projection for satisfactory breast reconstruction, the addition of an implant may be considered at the time of second-stage revisions. Dissection of an implant pocket beneath the flap may lead to the inadvertent injury of...

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Main Authors: Craig A. Blum, MD, Frank J. DellaCroce, MD, Scott K. Sullivan, MD, Chris Trahan, MD, M. Whitten Wise, MD
Format: Article
Language:English
Published: Wolters Kluwer 2018-03-01
Series:Plastic and Reconstructive Surgery, Global Open
Online Access:http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001734
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author Craig A. Blum, MD
Frank J. DellaCroce, MD
Scott K. Sullivan, MD
Chris Trahan, MD
M. Whitten Wise, MD
author_facet Craig A. Blum, MD
Frank J. DellaCroce, MD
Scott K. Sullivan, MD
Chris Trahan, MD
M. Whitten Wise, MD
author_sort Craig A. Blum, MD
collection DOAJ
description Background:. When a single perforator flap does not provide adequate volume or projection for satisfactory breast reconstruction, the addition of an implant may be considered at the time of second-stage revisions. Dissection of an implant pocket beneath the flap may lead to the inadvertent injury of the flap pedicle as the tissue planes have been obscured by tissue ingrowth. The authors present a technique in which the boundaries of the implant pocket are predetermined at the time of flap reconstruction allowing an implant to be inserted at the second stage in ideal position with greater ease of dissection and minimal risk to the flap pedicle. Methods:. Forty patients (80 bilateral perforator flap breast reconstructions) treated with the creation of central under flap pocket technique in anticipation of subsequent sub flap implant augmentation within an 18-month period were assessed retrospectively. Results:. Sixty-eight patients with flaps (85%) went on to receive secondary augmentation with silicone implants. The average percentage increase in volume contributed by the implant was 41%. The undersurface of the acellular dermal matrix was readily identified, and its medial most extent safely determined, allowing the expeditious recreation of the predelineated central under-flap implant pocket. No flap pedicles were injured during the process, and the implants were placed in a favorable position providing maximum projection to the reconstruction. No subsequent development of fat necrosis was identified after augmentation. Conclusion:. The creation of central under flap pocket technique allows for safe, effective, and expedient delayed implant augmentation of perforator flap breast reconstruction.
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spelling doaj.art-9c67510741a9404187ca794573a6d8742022-12-22T01:10:15ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742018-03-0163e173410.1097/GOX.0000000000001734201803000-00005Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast ReconstructionCraig A. Blum, MD0Frank J. DellaCroce, MD1Scott K. Sullivan, MD2Chris Trahan, MD3M. Whitten Wise, MD4From the Center for Restorative Breast Surgery, New Orleans, La.From the Center for Restorative Breast Surgery, New Orleans, La.From the Center for Restorative Breast Surgery, New Orleans, La.From the Center for Restorative Breast Surgery, New Orleans, La.From the Center for Restorative Breast Surgery, New Orleans, La.Background:. When a single perforator flap does not provide adequate volume or projection for satisfactory breast reconstruction, the addition of an implant may be considered at the time of second-stage revisions. Dissection of an implant pocket beneath the flap may lead to the inadvertent injury of the flap pedicle as the tissue planes have been obscured by tissue ingrowth. The authors present a technique in which the boundaries of the implant pocket are predetermined at the time of flap reconstruction allowing an implant to be inserted at the second stage in ideal position with greater ease of dissection and minimal risk to the flap pedicle. Methods:. Forty patients (80 bilateral perforator flap breast reconstructions) treated with the creation of central under flap pocket technique in anticipation of subsequent sub flap implant augmentation within an 18-month period were assessed retrospectively. Results:. Sixty-eight patients with flaps (85%) went on to receive secondary augmentation with silicone implants. The average percentage increase in volume contributed by the implant was 41%. The undersurface of the acellular dermal matrix was readily identified, and its medial most extent safely determined, allowing the expeditious recreation of the predelineated central under-flap implant pocket. No flap pedicles were injured during the process, and the implants were placed in a favorable position providing maximum projection to the reconstruction. No subsequent development of fat necrosis was identified after augmentation. Conclusion:. The creation of central under flap pocket technique allows for safe, effective, and expedient delayed implant augmentation of perforator flap breast reconstruction.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001734
spellingShingle Craig A. Blum, MD
Frank J. DellaCroce, MD
Scott K. Sullivan, MD
Chris Trahan, MD
M. Whitten Wise, MD
Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
Plastic and Reconstructive Surgery, Global Open
title Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
title_full Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
title_fullStr Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
title_full_unstemmed Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
title_short Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction
title_sort creation of a central under flap pocket allows secondary implant augmentation of perforator flap breast reconstruction
url http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001734
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