Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2016; 7(1): 114-121
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.114
Recent advances in microvascular autologous breast reconstruction after ablative tumor surgery
Michael S Pollhammer, Dominik Duscher, Manfred Schmidt, Georg M Huemer
Michael S Pollhammer, Dominik Duscher, Manfred Schmidt, Georg M Huemer, Section of Plastic, Aesthetic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital Linz, 4020 Linz, Austria
Michael S Pollhammer, Dominik Duscher, Manfred Schmidt, Georg M Huemer, MAZ - Microsurgical Training and Research Center, 4020 Linz, Austria
Author contributions: Pollhammer MS contributed to main writing of the manuscript, and figure and illustration preparation; Duscher D contributed to language editing, writing and revising of the manuscript; Schmidt M contributed to writing and revising of the manuscript; Huemer GM contributed to the idea of the study, writing and revising of the manuscript.
Conflict-of-interest statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Georg M Huemer, Associate Professor, MD, MBA, MSc, Chief of the Section of Plastic, Aesthetic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
Telephone: +43-732-780673819 Fax: +43-732-78063190
Received: July 19, 2015
Peer-review started: July 19, 2015
First decision: September 28, 2015
Revised: November 30, 2015
Accepted: December 8, 2015
Article in press: December 11, 2015
Published online: February 10, 2016

Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast reconstruction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.

Keywords: Breast cancer, Microsurgery, Autologous tissue transfer, Breast reconstruction, Flap, Transverse musculocutaneous gracilis, Fasciocutaneous infragluteal, Deep inferior epigastric perforator

Core tip: Mastectomy is a frequent sequela of the treatment and prophylaxis of breast malignancies. Autologous microvascular breast reconstruction is becoming the gold standard in correcting these disfiguring interventions. The lower abdomen, as well as the gluteal and thigh area, is the source of multiple flaps usable for breast reconstruction. With the advent of perforator flap surgery, today’s reconstructive surgeons are able to minimize donor site morbidity whilst maximizing patient outcomes. If timed and performed correctly, microsurgical breast reconstruction is a safe procedure with low donor site morbidities and excellent aesthetic results.