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A New Flap Design For Oncoplastic Breast Reconstruction: The Medial Pillar Island Flap
Mark G. Albert, M.D., Eleanor R. Goldwasser, M.D., Ashling O'Connor, M.D., Robert M. Quinlan, M.D., Mustafa Akyurek, M.D., Ph.D..
University of Massachusetts, Worcester, MA, USA.

PURPOSE:
The use of breast conservation therapy for isolated tumors is increasing in popularity. The lower pole of the breast has been emphasized as a flap donor site. However, limited flap mobility may be a shortcoming particularly for upper pole defects. This study presents the perforator-based inferior pole island flap for reconstruction of lumpectomy defects.
METHODS:
Sixteen cadaver breasts were infused with latex to evaluate internal mammary artery perforators and delineate vascular supply of the inferior pole of the breast. In 14 patients, upper pole defects were reconstructed with the medially-based perforator flap of the lower pole.
RESULTS:
Anatomic study revealed that the inferior pole island flap was consistently supplied by the lower IMA perforators at an average of 8.5cm from the midline in the 4th interspace, and 3cm from the midline in the 5th interspace. Clinical experience demonstrated uneventful flap survival in all the cases. One patient developed a post-operative hematoma, and 2 patients required mastectomy for positive margins.
CONCLUSIONS:
This study introduces the perforator-based inferior pole island flap. It is a new design to utilize the lower pole of the breast, with reliable vascularity and unrestricted mobility, to reconstruct lumpectomy defects of the entire upper aspect of the breast. Furthermore, use of a separate superomedial pedicle flap, along with the described lower pole flap, allows for a refined reconstruction of the breast.


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