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Address for correspondence: Rajendra Prasad J. S., Assistant Plastic Surgeon, Plastic and Reconstructive Services, Tata Memorial
Hospital, Dr. Ernest Borges Marg, Parel, Mumbai, India. E-mail: rprasad7@hotmail.com
ABSTRACT
The most common methods of breast reconstruction involve harvest of flaps from the lower
abdomen. However it has certain limitations, including its use in patients who desire pregnancy in
the future. Here, the anterolateral thigh flap, though an unconventional donor site, has been used
with good results in four of our patients.
KEY WORDS
T
he progress in microsurgical procedures has led popularity due to its minimal donor site morbidity.
to significant technological scientific and However there are some contraindications for using
clinical advances that have made these it such as inadequate soft tissue volume, previous
procedures safe, reliable, reproducible and routine in abdominoplasty, lower paramedian and multiple
most major medical centers. In many instances free abdominal scars and plans for future pregnancy. In
flap reconstruction has become the primary such situations a gluteal flap has been the second
reconstructive method for many major defects, option. However the quality of adipose tissue here is
including breast reconstruction. Better flap inferior to that of lower abdominal flaps. Also the
vascularity, broader patient selection, easier insetting pedicle is short and a two team approach is difficult
of the flap and decreased donor site morbidity are with gluteal artery flap. In these situations the
the main advantages of microsurgical reconstruction.1 anterolateral thigh flap is an useful option which has
Over the past two decades, significant advances have been recently reported for breast reconstruction
been made in the treatment of breast cancer and whenever contraindications for harvesting abdominal
reconstruction following mastectomy. For selection tissue exist.3
of the optimal method of reconstruction several
factors must be considered. The most important are Here we present our experience of using anterolateral
the type of the mastectomy defect, patient factors thigh flaps in breast reconstruction in four such
and the patient’s choice regarding timing and patients.
selection of donor tissue.2 The transverse rectus
abdominis muscle (TRAM) flap is the most popular in MATERIAL AND METHODS
free flap breast reconstruction.1 Also, in recent times
the deep inferior epigastric perforator flap, which From November 2002 to October 2003, four cases of
uses the same skin-fat island is increasingly gaining breast reconstruction were performed with
recovery was uneventful. carcinoma of right breast. She desired future pregnancy
and thus opted for the anterolateral thigh flap. She had
Case 2 medium size breasts. A modified radical mastectomy with
A 31-year-old married lady presented with infiltrating duct simultaneous reconstruction with the anterolateral thigh
Figure 1: CASE 1 The pre-operative front view Figure 4: The harvested flap ready for transfer and the excised breast
specimen en bloc with the axillary tissue
Figure 2: The pre-operative lateral view Figure 5: Ten months after reconstruction, showing the front view
Figure 3: The flap marking showing the skin paddle and the fat-fascia extension Figure 6: Ten months after reconstruction, showing the lateral view
Figure 7: Well settled thigh scar with acceptable contour Figure 8: CASE 2 The pre-operative front view
DISCUSSION
In our country, there has been a sharp rise in the (Case 2) with a large phylloides tumour required a
incidence of breast cancer in the young population and minor secondary correction to match both the breasts
certain skepticism exists with regard to use of and this was performed at the time of nipple-areola
abdominal tissue. There is a recent report of breast reconstruction. Both have subsequently married.
reconstruction with anterolateral thigh flap, whenever
contraindications for use of lower abdomen exist.3 This In conclusion, we would like to recommend free
flap provides satisfactory bulk, more subcutaneous anterolateral thigh flap as an alternative option for free
tissue by undermining of the skin flaps beyond the flap flap breast reconstruction in the absence of availability
paddle, better pliability and allows a two team of abdominal flaps.
approach. Anterolateral thigh flap is becoming a
preferred donor site for free tissue transfer in the Asian REFERENCES
countries, particularly since the thigh scar is usually
well concealed in conventional clothes. In our unit too, 1. Joseph SM, Steven ML. Microvascular reconstruction of the
breast. Semin Surg Oncol 2000;19:264.
it is commonly used for head-neck and groin 2. Trabulsy PP, Anthony JP, Mathes SJ. Changing trends in post
reconstruction after cancer extirpation. With this mastectomy breast reconstruction - A 13 year experience. Plast
Reconstr Surg 1994;93:1418.
familiarity and the need to spare the abdomen we chose
3. Fu-Chan Wei, Sinikka Suominen, Ming-huei Cheng, et al.
to reconstruct our patients with this flap. This flap has Anterolateral thigh flap for post mastectomy breast
a consistent and reliable vascular basis and is easy to reconstruction. Plast Reconstr Surg 2002;110:82.
4. Stephen KS. General Principles of free flap breast reconstruction
harvest. The slight contour deformity and the linear Microsurgical reconstruction of the cancer patient. 1997;7:151.
scar in the thigh are disadvantages of this donor site. 5. John SM, Elliot FL II. Lateral transverse thigh flap and the deep
circumflex iliac soft tissue flap (Rubens flap). Microsurgical
The functional abnormality due to the loss of vastus reconstruction of the cancer patient. 1997;11:205.
lateralis muscle is not significant. However, the motor 6. Takeishi M, Shaw WW, Ahn CY, Borud LJ. TRAM flaps in patients
nerve branches to the other quadriceps muscles should with abdominal scars. Plast Reconstr Surg 1997;99:713.
7. Grotting JC,Urist MM, Maddox WA, Vasconez LO. Conventional
be carefully preserved while dissection of the flap. In TRAM flap versus free microsurgical TRAM flap for immediate
one case (Case 4) the skin perforators were of the breast reconstruction. Plast Reconstr Surg 1989;83:82.
8. Arnez ZM, Valdatta L, Tyler MP, Planinsek F. Anatomy of Internal
septocutaneous variety, hence no muscle was included mammary veins and their use in free TRAM flap breast
in the flap. All of them had adequate bulk and reconstruction. Br J Plast Surg 1995;48:540.
acceptable cosmesis. One patient (Case 1) required 9. Chen L, Hartrampf CR Jr, Bennet GK. Successful pregnancies
following TRAM flap surgery. Plast Reconstr Surg 1993;91:69.
chemotherapy and radiation therapy after 10. Feller Axel-Mario, Thomas GJ. Deep inferior epigastric artery
reconstruction and tolerated both well. Another patient perforator flap. Clin Plast Surg 1998;25:2.