PURPOSE: To describe a novel technique for supplementing breast size for aesthetic or reconstructive purposes while simultaneously rejuvenating the abdomen. Upper abdominal adipofascial flaps are de-epithelialized and transposed to the breast mound while reverse abdominoplasty accomplishes donor site closure aesthetically. Periumbilical perforators are preserved in the central abdomen preserving important vascularity to the abdominal apron enabling use of this technique when cholecystectomy and other abdominal scars would otherwise preclude conventional abdominoplasty. METHODS: Thirty five cases of breast reconstruction and cosmetic breast augmentation with reverse abdominoplasty were applied to a wide variety of complex clinical scenarios many of which had contraindications for conventional abdominoplasy. Aesthetic candidates had adipofascial flaps with superiorly based vasculature while reconstructive patients were either superiorly or, more commonly, inferiorly based.
RESULTS: Successful improvement of both breast and abdominal sites was achieved in nearly all cases. Since the first case performed in 1997 post operative mammography has shown no abnormalities. Size increases of 200-400 cc per breast were routinely observed. Average long term follow-up was 3.2 years. Major complication rate was 11.4% and all were involving inferiorly based flaps. Two major complications secondary to previous radiation in inferiorly based flaps patients suggest it's limited use in this subgroup of patients.
CONCLUSION: The Ambra procedure offers both reconstructive and aesthetic surgeons another significant surgical option for selected patients that possess this highly expendible donor site.