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Breast reconstruction using free medial circumflex artery perforator flaps: intraoperative anatomic study and clinical results

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An Erratum to this article was published on 28 November 2016

Abstract

Background

A free fascioadipocutaneous flap obtained from the medial thigh is suitable for breast reconstruction in Asian women with a small-to-moderate breast size. In this region, both a medial circumflex femoral artery perforator flap (MCFAp flap) and a posterior medial thigh perforator flap (PMTp flap) are options, based on perforators from the deep femoral vessels. Here, we evaluated the anatomic basis of the medial circumflex femoral artery (MCFA) perforators from the medial circumflex femoral vessels.

Methods

Between July 2010 and June 2014, 53 patients (55 flaps) underwent breast reconstruction using a fascioadipocutaneous flap from the medial thigh. MCFA perforators larger than or equal to 0.5 mm in this region were investigated. The following parameters were recorded intraoperatively: number of perforators, perforator locations, distance of the perforating point from the proximal thigh crease and anterior border of the gracilis muscle.

Results

The total number of perforators was 131, with a mean of 2.4. The number of perforators coursing through the gracilis muscle (gracilis perforators) was the largest, followed by septocutaneous perforator coursing between the adductor longus and gracilis muscle. The average perforating point was located 6.5 cm below the proximal thigh crease and 2.2 cm from the anterior border of the gracilis muscle. Of the 102 procedures performed since 2006, 15 flaps were elevated as MCFAp flaps and there was no major complication.

Conclusions

In some cases, MCFA perforators are dominant in this region compared to PMT perforators. A perforator map can be helpful for identifying adequate MCFA perforators intraoperatively.

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References

  1. Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2009;7:122–92.

    CAS  Google Scholar 

  2. Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Plast Reconstr Surg. 1976;58:371–4.

    Article  CAS  PubMed  Google Scholar 

  3. Campaneria MC, Wong WW, Hill ME, Gupta SC. The evolution of breast reconstruction: a historical perspective. World J Surg. 2012;36:730–42.

    Article  Google Scholar 

  4. McCraw JB, et al. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg. 1976;58:176–83.

    Article  CAS  PubMed  Google Scholar 

  5. Yousif NJ, Matloub HS, Kolachalam R, Grunert BK, Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg. 1992;29:482–90.

    Article  CAS  PubMed  Google Scholar 

  6. Peek A, Mueller M, Exner K. The free gracilis perforator flap for autologous breast reconstruction (in German with English abstract). Handchir Mikrochir Plast Chir. 2002;34:245–50.

    Article  CAS  PubMed  Google Scholar 

  7. Peek A, Mueller M, Ackermann G, Exner K. Baumeister Steffen. The free gracilis perforator flap: anatomical study and clinical refinements of a new perforator flap. Plast Reconstr Surg. 2009;123:578–88.

    Article  CAS  PubMed  Google Scholar 

  8. Satake T, Muto M, Ko S, Yasumura K, Ishikawa T, Maegawa J. Breast reconstruction using free posterior medial thigh perforator flaps: intraoperative anatomic study and clinical results. Plast Reconstr Surg. 2014;134:880–91.

    Article  CAS  PubMed  Google Scholar 

  9. Heckler FR. Gracilis myocutaneous and muscle flap. Clin Plast Surg. 1980;7:27–44.

    CAS  PubMed  Google Scholar 

  10. Sugawara J, Satake T, Muto M, Ko S, Yasumura K, Ishikawa T, et al. Dynamic blood flow to the retrograde limb of the internal mammary vein in breast reconstruction with free flap. Microsurgery. 2015;35:622–6. doi:10.1002/micr.22500.

    Article  PubMed  Google Scholar 

  11. Kaariainen M, Giordano S, Kauhanen S, Laaperi AL, Mattila P, Helminen M, et al. The significance of latissimus dorsi flap innervation in delayed breast reconstruction: a prospective randomized study-magnetic resonance imaging and histologic findings. Plast Reconstr Surg. 2011;128:637–45.

    Article  Google Scholar 

  12. Arnez ZM, Pogorelec F, Planinsek F, Ahcan U. Breast reconstruction by the free transverse gracilis (TUG) flap. Br J Plast Surg. 2004;57:20–6.

    Article  CAS  PubMed  Google Scholar 

  13. Schoeller T, Huemer GM, Wechselberger G. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection. Plast Reconstr Surg. 2008;122:29–38.

    Article  CAS  PubMed  Google Scholar 

  14. Hallock GG. The medial circumflex femoral gracilis local perforator flap-a local medial groin perforator flap. Ann Plast Surg. 2003;51:460–4.

    Article  PubMed  Google Scholar 

  15. Hallock GG. Further experience with the medial circumflex femoral gracilis perforator free flap. J Reconstr Microsurg. 2004;20:115–22.

    Article  PubMed  Google Scholar 

  16. Izumi K, Fujikawa M, Tashima H, Saito T, Sotsuka Y, Tomita K, et al. Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery. J Plast Reconstr Aesthet Surg. 2013;66:1528–33.

    Article  PubMed  Google Scholar 

  17. Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg. 2012;129:16–23.

    Article  Google Scholar 

  18. Lykoudis EG, Spyropoulou GCh, Vlastou CC. The anatomic basis of the gracilis perforator flap. Br J Plast Surg. 2005;58:1090–4.

    Article  PubMed  Google Scholar 

  19. Lykoudis EG, Spyropoulou GCh, Vlastou CC. The conjoint circumflex femoral perforator and gracilis muscle free flap: anatomical study and clinical use for complex facial paralysis reconstruction. Plast Reconstr Surg. 2005;116:1589–95.

    Article  CAS  PubMed  Google Scholar 

  20. Kappler UA, Constantinescu MA, Buechler U, Voegelin E. Anatomy of the proximal cutaneous perforator vessels of the gracilis muscle. Br J Plast Surg. 2005;58:445–8.

    Article  CAS  PubMed  Google Scholar 

  21. Trignano E, Fallico N, Dessy L, Armenti AF, Scuderi N, Rubino C, et al. Transverse upper gracilis flap with implant in postomastectomy breast reconstruction: a case report. Microsurgery. 2014;34:149–52. doi:10.1002/micro.22165.

    Article  PubMed  Google Scholar 

  22. Ciudad P, Maruccia M, Orfaniotis G, Weng HC, Constantinescu T, Nicoli F, et al. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction. Microsurgery. 2015;00:000. doi:10.1002/micr.22459.

    Google Scholar 

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan

    Mai Shibuya, Toshihiko Satake, Reiko Nakasone, Marina Ogawa, Mayu Muto, Kazunori Yasumura & Jiro Maegawa

  2. Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan

    Kazutaka Narui

  3. Department of Breast Oncology, Tokyo Medical University Hospital, Tokyo, Japan

    Takashi Ishikawa

  4. Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan

    Jiro Maegawa

Authors
  1. Mai Shibuya
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  2. Toshihiko Satake
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  3. Reiko Nakasone
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  4. Marina Ogawa
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  5. Mayu Muto
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  6. Kazutaka Narui
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  7. Kazunori Yasumura
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  8. Takashi Ishikawa
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  9. Jiro Maegawa
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Corresponding author

Correspondence to Mai Shibuya.

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The authors declare that they have no conflicts of interest to disclose.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s12282-016-0745-9.

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Shibuya, M., Satake, T., Nakasone, R. et al. Breast reconstruction using free medial circumflex artery perforator flaps: intraoperative anatomic study and clinical results. Breast Cancer 24, 458–464 (2017). https://doi.org/10.1007/s12282-016-0728-x

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  • DOI: https://doi.org/10.1007/s12282-016-0728-x

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