Abstract

MENDIETA-ESPINOSA, M.; GUTIERREZ-GOMEZ, S.M.  and  FRECH-ALVAREZ, G.. Unification of the aesthetic subunits of the breast in postmastectomy authologous reconstruction. Cir. plást. iberolatinoam. [online]. 2015, vol.41, n.4, pp.373-384. ISSN 1989-2055.  https://dx.doi.org/10.4321/S0376-78922015000400004.

The restoration of the breast is an essential component in the curative treatment of cancer after mastectomy, as a scar or reconstruction with a poor cosmetic outcome translates into constant reminder of the disease. We propose a model of aesthetic subunits of the breast for mammary reconstruction, since the breast itself has different volume distribution that are characteristic of each patients body habitus, and avoiding in the reconstruction a single focal point in the perfectible breast. A total of 32 abdominally base flap reconstructions were performed for the restoration and integration of the subunits, as the abdominal flaps offers the advantage of being molded according to need, a characteristic not met by the use of alloplastic materials, for soft transition of the chest wall to the observer. The reconstruction of the nipple areola complex, procedures for symmetrization of healthy native breast, such as reduction or mastopexy, were performed 6 months after the initial procedure, where we can use the same subunits to assess the outcome and improve areas of continuity with lipoinjection application of fat or scar revision. Twenty-eight of the reconstructions, had a good contour of the flap in continuity with the chest wall, and proper positioning of the breast groove with good symmetry with the contralateral breast. Four reconstructions failed to unifiy the subunits of the breast, 2 of them with an appearance of patch flap, and 2 with a low positioning of the new inframamary fold. The proposed subunit principle approach to breast reconstruction may be used effectively in preoperative planning and second staged procedures, to obtain superior aesthetic outcomes in breast reconstruction, with a good flap positioning, volume distribution and incision placement and direction, having as a result the unification of the subunits as a whole.

Keywords : Aesthetic subunits of the breast; Breast reconstruction; Abdominally based flaps.

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