Reconstruction of the breast with a contralateral epigastric rectus myocutaneous flap

Summary

The contralateral epigastric rectus flap (ERF) is a new myocutaneous flap, recently proposed by Vasconez. It is composed of two island flaps including epigastric skin taken along the submammary fold, and the upper part of the rectus abdominis muscle with the superior epigastric artery. It usually measures 20 × 8 cm. In breast reconstruction the ERF is transferred from the normal side to the mastectomized side on its vascular pedicle. The donor site is hidden in the submammary fold. The ERF can be used either for skin or volume replacement. It has many advantages over the latissimus flap (larger amount of skin, skin comparable to breast skin, taken without position change during surgery, no muscle dysfunction, no donor site in the back, upper abdominal lift with major addition of homolateral epigastric skin to the reconstruction), but cannot replace it in patients with thin or irradiated skin, where muscle addition is needed.