12. The fasciocutaneus infragluteal (FCI)-flap: An additional choice for breast reconstruction and augmentation.

Purpose
Breast reconstruction is often difficult on slim women where autologous tissue as latissimus dorsi or TRAM don’t provide sufficient tissue. As a growing number of younger patients refuse reconstructions or augmentations with silicone prothesis we started looking for a reliable and aesthetical pleasing alternative offering a bigger volume of soft tissue as the lower abdomen can provide.
The infragluteal flap , a new fasiocutaneus flap based on the descending branch of the inferior gluteal artery seems to meet this expectations. In contrast to the well known gluteus superior or inferior flap no muscle is included and thus donor-site morbidity is minimal.
The transverse skin paddle allows the donor-site scar to bee totally hidden in the infragluteal crease.
Methods
Between 1996 and 2004 46 FCI flaps were performed. 22 patients received uni- or bilateral breast reconstruction . On special request 6 women had bilateral simultaneus breast augmentations with FCI-flaps.Breast asymetry was corrected in 5 patients. The average age of patients at the time of operation age was 39.2 years.
In 4 patient a controlateral mastopexy was performed to obtain a better breast symmetry. The presence of the descending branch of the infragluteal artery was assessed preoperativitly using colour duplex sonography
Surgery was performed with the patient in a prone, jack-knife position. The flap was designed as a transverse ellipse along the direction of the infragluteal fold.
In breast reconstruction both thoracodorsal and mammaria interna vessels were uesed for anastomosis. A small subaxillary incision was prefered for flap positioning and anastomosis with the thoracodorsal vessels when augmentations were performed.
RESULTS

For all women who had breast reconstruction no total, but one partial flap loss occurred. Two operative revision for seroma formation and two for haematoma was performed. 19 patients showed a transitory decrease of sensibility on the dorsal leg and 2 had a loss of sensibility. The aesthetical result in the breast augmentation group was judged as good or very good in 27 cases, as fair in 2 cases and as poor in 4 cases. No functional donor-site morbidity was encountered..

Conclusions
The FCI-flap is in our experience a additional and reliable choice for breast reconstruction and augmentation exspecially on thinner women. It seems particular uesfull if a previous reconstruction with another free flap failed or in cases of recurrend capsel fibrosis. The inconspicuous donor site scar and the softness of the reconstructed breast are additionnal advantages of the FCI-flap.

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