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Thoraco-Epigastric Pedicled Flap for Partial Breast Reconstruction

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Oncoplastic Breast Surgery Techniques for the General Surgeon

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Abstract

Thoraco-epigastric (TE) flaps can be used for immediate partial breast reconstruction as a volume replacement oncoplastic technique. It is usually offered for patients with small- or medium-sized breasts, when we would expect significant cosmetic deformity after breast-conserving surgery for tumours located in the lower inner quadrant if they were treated with wide local excision only. Similarly, the axial thoraco-abdominal (TA) flap – which is the mirror flap of the thoraco-epigastric flap – can be offered for volume replacement for tumours excised from the lower outer quadrant of the breast.

TE and TA flaps are loco-regional transposition flaps, which utilise local tissue in a rotation or advancement fashion. They are planned around the loose skin and subcutaneous adipose tissue “roll” located underneath the breast just inferior to the inframammary fold. The blood supply of the TE flap is dependent on the sixth perforating branch of the internal thoracic (mammary) artery, while the lateral cutaneous branch of the posterior intercostal artery provides vascularisation for the TA flap.

Reliability and the relative safety of these flaps are their primary advantage. In addition, their preparation requires fairly simple surgical technique without the need of training in microsurgery. The flaps can be fully or partially de-epithelised, or not de-epithelised at all. As these flaps are compositionally similar to the original breast skin, the patient experience is relatively good as there is no skin patch effect in case the breast skin overlying the cancer needs to be replaced, too.

In selected patients, indications may be extended. Longer TE and TA flaps can reach up to the relevant upper quadrants. In some patients TE or TA flaps can be used to replace defects after central excision in the breast, too.

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References

  1. Noguchi M, Yokoi-Noguchi M, Ohno Y, Morioka E, Nakano Y, Kosaka T, et al. Oncoplastic breast conserving surgery: volume replacement vs. volume displacement. Eur J Surg Oncol. 2016;42(7):926–34.

    Article  CAS  PubMed  Google Scholar 

  2. Mansell J, Weiler-Mithoff E, Stallard S, Doughty JC, Mallon E, Romics L. Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast. 2017;32:179–85.

    Article  CAS  PubMed  Google Scholar 

  3. Dakin RL, Jobe RP. Toward a more natural breast: the interpolated thoracoepigastric pedicle in breast reconstruction. Plast Reconstr Surg. 1991;88(3):510–3.

    Article  CAS  PubMed  Google Scholar 

  4. Cronin TD, Upton J, McDonough JM. Reconstruction of the breast after mastectomy. Plast Reconstr Surg. 1977;59(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  5. Huemer GM. Partial mastectomy: breast reconstruction with the pedicled thoracoepigastric flap. In: Fitzal F, Schrenk P, editors. Oncoplastic breast surgery a guide to clinical practice. Vienna: Springer; 2010. p. 127–32.

    Google Scholar 

  6. Acea Nebril B, Builes Ramirez S, Garcia Novoa A, Varela Lamas C. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations. Cirugia Espanola. 2016;94(7):372–8.

    Article  PubMed  Google Scholar 

  7. Brown RG, Vasconez LO, Jurkiewicz MJ. Transverse abdominal flaps and the deep epigastric arcade. Plast Reconstr Surg. 1975;55(4):416–21.

    Article  CAS  PubMed  Google Scholar 

  8. Hamdi M, Craggs B, Stoel AM, Hendrickx B, Zeltzer A. Superior epigastric artery perforator flap: anatomy, clinical applications, and review of literature. J Reconstr Microsurg. 2014;30(7):475–82.

    Article  PubMed  Google Scholar 

  9. Hamdi M, Stillaert FB. Pedicled perforator flaps in the trunk. Clin Plast Surg. 2010;37(4):655–65. vii.

    Article  PubMed  Google Scholar 

  10. Beahm EK. Timing and key considerations in reconstruction for breast-conserving therapy. In: Nahabedian MY, editor. Oncoplastic surgery of the breast. Washington, DC: Saunders; 2009. p. 21–45.

    Google Scholar 

  11. Losken A. Reconstruction of partial mastectomy defects: classification and methods. In: Spear SL, editor. Surgery of the breast: principles and art, vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 140–64.

    Google Scholar 

  12. Hamdi M, Van Landuyt K, Ulens S, Van Hedent E, Roche N, Monstrey S. Clinical applications of the superior epigastric artery perforator (SEAP) flap: anatomical studies and preoperative perforator mapping with multidetector CT. J Plast Reconstr Aesth Surg: JPRAS. 2009;62(9):1127–34.

    Article  Google Scholar 

  13. Mansell J, Weiler-Mithoff E, Martin J, Khan A, Stallard S, Doughty JC, et al. How to compare the oncological safety of oncoplastic breast conservation surgery – to wide local excision or mastectomy? Breast. 2015;24(4):497–501.

    Article  CAS  PubMed  Google Scholar 

  14. Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012;99(10):1389–95.

    Article  CAS  PubMed  Google Scholar 

  15. Park HC, Kim HY, Kim MC, Lee JW, Chung HY, Cho BC, et al. Partial breast reconstruction using various oncoplastic techniques for centrally located breast cancer. Arch Plast Surg. 2014;41(5):520–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Khan J, Barrett S, Forte C, Stallard S, Weiler-Mithoff E, Doughty JC, et al. Oncoplastic breast conservation does not lead to a delay in the commencement of adjuvant chemotherapy in breast cancer patients. Eur J Surg Oncol. 2013;39(8):887–91.

    Article  CAS  PubMed  Google Scholar 

  17. Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471–81.

    Article  CAS  PubMed  Google Scholar 

  18. Matros E, Disa JJ. Uncommon flaps for chest wall reconstruction. Semin Plast Surg. 2011;25(1):55–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Baroudi R, Pinotti JA, Keppke EM. A transverse thoracoabdominal skin flap for closure after radical mastectomy. Plast Reconstr Surg. 1978;61(4):547–54.

    Article  CAS  PubMed  Google Scholar 

  20. Della Rovere GQ. Skin incisions, glandular reshaping, and local flaps. In: Della Rovere GQ, Benson JR, Nava M, editors. Oncoplastic and reconsructive surgery of the breast, vol. 2. Boca Raton: CRC Press; 2010. p. 138–40.

    Chapter  Google Scholar 

  21. Campbell EJ, Romics L. Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature. Breast Cancer (Dove Medical Press). 2017;9:521–30.

    PubMed Central  Google Scholar 

  22. Clough KB, Gouveia PF, Benyahi D, Massey EJ, Russ E, Sarfati I, et al. Positive margins after oncoplastic surgery for breast cancer. Ann Surg Oncol. 2015;22(13):4247–53.

    Article  PubMed  Google Scholar 

  23. Dolan R, Patel M, Weiler-Mithoff E, Mansell J, Stallard S, Doughty JC, et al. Imaging results following oncoplastic and standard breast conserving surgery. Breast Care (Basel, Switzerland). 2015;10(5):325–9.

    Article  PubMed Central  Google Scholar 

  24. Perez-Cano R, Vranckx JJ, Lasso JM, Calabrese C, Merck B, Milstein AM, et al. Prospective trial of adipose-derived regenerative cell (ADRC)-enriched fat grafting for partial mastectomy defects: the RESTORE-2 trial. Eur J Surg Oncol. 2012;38(5):382–9.

    Article  CAS  PubMed  Google Scholar 

  25. Romics L, Macaskill J, Fernandez T, Simpson L, Morrow E, Pitsinis V, et al. Outcomes from the Scottish audit of oncoplastic breast conservations: surgical techniques, incomplete excision rate and complications – analysis of 498 patients from 11 units. Eur J Surg Oncol. 2017;43(5):S31.

    Article  Google Scholar 

  26. Kronowitz SJ, Feledy JA, Hunt KK, Kuerer HM, Youssef A, Koutz CA, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg. 2006;117(1):1–11. discussion 2–4.

    Article  CAS  PubMed  Google Scholar 

  27. Ho W, Stallard S, Doughty J, Mallon E, Romics L. Oncological outcomes and complications after volume replacement oncoplastic breast conservations-the Glasgow experience. Breast Cancer: Basic Clin Res. 2016;10:223–8.

    Google Scholar 

  28. Yiannakopoulou EC, Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: systematic review. Eur J Surg Oncol. 2016;42(5):625–30.

    Article  CAS  PubMed  Google Scholar 

  29. Lee J, Jung JH, Kim WW, Hwang SO, Kang JG, Baek J, et al. Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: a single center analysis. Surg Oncol. 2015;24(1):35–40.

    Article  PubMed  Google Scholar 

  30. Losken A, Schaefer TG, Carlson GW, Jones GE, Styblo TM, Bostwick J 3rd. Immediate endoscopic latissimus dorsi flap: risk or benefit in reconstructing partial mastectomy defects. Ann Plast Surg. 2004;53(1):1–5.

    Article  PubMed  Google Scholar 

  31. Yang JD, Kim MC, Lee JW, Cho YK, Choi KY, Chung HY, et al. Usefulness of oncoplastic volume replacement techniques after breast conserving surgery in small to moderate-sized breasts. Arch Plast Surg. 2012;39(5):489–96.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lee JW, Kim MC, Park HY, Yang JD. Oncoplastic volume replacement techniques according to the excised volume and tumor location in small- to moderate-sized breasts. Gland Surg. 2014;3(1):14–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Park JS, Ahn SH, Son BH, Kim EK. Using local flaps in a chest wall reconstruction after mastectomy for locally advanced breast cancer. Arch Plast Surg. 2015;42(3):288–94.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sood A, Daniali LN, Rezzadeh KS, Lee ES, Keith J. Management and reconstruction in the breast cancer patient with a fungating T4b tumor. Eplasty. 2015;15:e39.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, New Victoria Hospital, Glasgow, UK

    Laszlo Romics

  2. Department of Academic Surgery, University of Glasgow, Glasgow, UK

    Laszlo Romics & Elizabeth Morrow

  3. Canniesburn Plastic Surgical Unit, Glasgow Royal Infirmary, Glasgow, UK

    Eva Weiler-Mithoff

Authors
  1. Laszlo Romics
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  2. Eva Weiler-Mithoff
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  3. Elizabeth Morrow
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Corresponding author

Correspondence to Laszlo Romics .

Editor information

Editors and Affiliations

  1. University of Texas Medical Branch, Galveston, TX, USA

    V. Suzanne Klimberg

  2. Breast Surgery, Guy’s and St. Thomas’ Hospital, King’s College London Guy’s and St. Thomas’ Hospital, London, UK

    Tibor Kovacs

  3. Clinica Universidad de Navarra, Universidad de Navarra, Madrid, Spain

    Isabel T. Rubio

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Romics, L., Weiler-Mithoff, E., Morrow, E. (2020). Thoraco-Epigastric Pedicled Flap for Partial Breast Reconstruction. In: Klimberg, V., Kovacs, T., Rubio, I. (eds) Oncoplastic Breast Surgery Techniques for the General Surgeon. Springer, Cham. https://doi.org/10.1007/978-3-030-40196-2_15

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  • DOI: https://doi.org/10.1007/978-3-030-40196-2_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-40195-5

  • Online ISBN: 978-3-030-40196-2

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