Advertisement

Oncoplastic reconstruction of central lumpectomy defects using the medial pillar island flap

Published:April 17, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.102

      Summary

      Purpose

      This report presents the medial pillar island flap technique of oncoplastic breast reconstruction of central defects that involve the nipple-areola complex.

      Methods

      The procedure was performed in patients who presented with inferior pole redundancy using a vertical mammaplasty pattern. The flap was designed utilizing the territory of the lower pole as an island flap pedicled by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar.

      Results

      Eight patients underwent the procedure with a mean age of 57.6 years. Median breast cup size was D (range: from C to DDD). The mean body mass index was 37.3 kg/m2 (range: from 32.1 to 41.5). The size of the defect ranged from 64 to 150 cm3 (mean, 97.2). Concomitant opposite breast vertical reduction was performed in 6 cases. Flap survival was uneventful. Nipple reconstruction was performed 6 months after radiation treatment in 4 patients. No major complications were encountered. Two patients developed minor wound breakdown after nipple reconstruction.

      Conclusions

      The medial pillar island flap is presented as a safe and reliable option for the reconstruction of central partial mastectomy defects in patients with macromastia or breast ptosis. Internal mammary system provides predictable and robust flap viability while complete separation from the inframammary fold allows for unrestricted mobility. The procedure is designed with vertical scar mammaplasty, which results in a smooth contour to the lower pole. The flap allows for nipple reconstruction using well-vascularized skin paddle. The technique is offered as an alternative oncoplasty option for neoareolar reconstruction.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Matsen CB
        • Neumayer LA.
        Breast cancer: a review for the general surgeon.
        JAMA Surg. 2013; 148: 971-979
        • Sohn VY
        • Arthurs ZM
        • Sebesta JA
        • Brown TA.
        Primary tumor location impacts breast cancer survival.
        Am. J. Surg. 2008; 195: 641-644
        • Shechter S
        • Friedman O
        • Inbal A
        • Arad E
        • Menes T
        • Barsuk D
        • Gur E
        • Barnea Y.
        Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumors.
        ANZ J Surg. 2019; 89: 536-540
        • Akyurek M
        • Tomczyk E
        • Albert M
        • Quinlan R.
        The medial pillar island flap for oncoplastic breast reconstruction of upper pole defects.
        Ann. Plast. Surg. 2019; 82: 375-381
        • Carstensen L
        • Bigaard J.
        Management of central breast tumours with immediate reconstruction of the nipple-areola complex; a suggested guide.
        The Breast. 2015; 24: 38-45
        • Naguib SF.
        Oncoplastic resection of retroareolar breast cancer; central quadrantectomy and reconstruction by local skin-glandular flap.
        J. Egypt. Natl. Canc. Inst. 2006; 18: 334-347
        • Carty H
        • McCullough P
        • Aluwihare N
        • Matey P.
        Breast conserving surgery for breast cancer involving the nipple.
        Breast. 2008; 17: 109-112
        • Galimberti V
        • Zurrida S
        • Zanini V
        • Callegari M
        • Veronesi P
        • Catania S
        • et al.
        Central small size breast cancer: how to overcome the problem of nipple and areola involvement.
        Eur. J. Cancer. 1993; 29A: 1093-1096
        • Huemer GM
        • Schrenk P
        • Moser F
        • Wagner E
        • Wayand W.
        Oncoplastic techniques allow breast-conserving treatment in centrally located breast cancers.
        Plast. Reconstr. Surg. 2007; 120: 390-398
        • McCulley SJ
        • Durani P
        • Macmillan RD.
        Therapeutic mammaplasty for centrally located breast tumors.
        Plast. Reconstr. Surg. 2006; 117: 366-373
        • Fitzal F
        • Nehrer G
        • Hoch D
        • Riedl O
        • Gutharc S
        • Deutinger M
        • et al.
        An oncoplastic procedure for central and medio-cranial breast cancer.
        Eur. J. Surg. Oncol. 2007; 33: 1158-1163
        • Schoeller T
        • Huemer GM.
        Immediate reconstruction of the nipple areola complex in oncoplastic surgery after central quadrantectomy.
        Ann. Plast. Surg. 2006; 57: 611-615
        • Moustafa A
        • Fakhr I.
        Outcome of different oncoplastic surgical techniques for centrally located breast cancer.
        J. Egypt. Natl. Canc. Inst. 2014; 26: 203-209
        • Grisotti A.
        Immediate reconstruction after partial mastectomy. Operative techniques.
        Plast. Reconstr. Surg. 1994; 1: 1-12
        • Levine JL
        • Soueid NE
        • Allen RJ.
        Algorithm for autologous breast reconstruction for partial mastectomy defects.
        Plast. Reconstr. Surg. 2005; 116: 762-767
        • Rose M
        • Svensson H.
        Tunnelled lateral fasciocutaneous thoracodorsal flap with a skin island in breast reconstruction in oncoplastic breast surgery.
        J. Plast. Surg. Hand Surg. 2012; 46: 404-409
        • Akyurek M.
        Vertical mastopexy and lateral intercostal artery perforator (LICAP) flap with pectoralis muscle sling for autologous tissue breast augmentation in the bariatric patient.
        Ann. Plast. Surg. 2011; 66: 29-35
        • Akyurek M.
        Contouring the inferior pole of breast in vertical mammaplasty. Suction-assisted lipectomy versus direct defatting.
        Plast. Reconstr. Surg. 2011; 127: 1314-1322
        • Akyurek M
        • Chappell A
        Short scar mammaplasty in severe macromastia.
        Ann. Plast. Surg. 2016; 77: 609-614