Aesthetic modification for delayed autologous breast reconstruction: using a thoracodorsal flap to create a breast pocket.

Abstract

Many patients still undergo delayed breast reconstruction. Although advances in transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction have led to the achievement of a satisfactory shape, the aesthetic result is often marred by the obvious color and texture differences between the abdominal skin and the breast. After mobilizing the mastectomy flaps, the author raises a thoracodorsal flap, which creates a "breast pocket" that is filled with a deepithelialized TRAM flap. This technique has been used in three patients. The advantage of this technique is that it enables a better "aesthetic" reconstruction in that the color and texture of the breast skin is better than that obtained with the abdominal skin from the TRAM flap. The disadvantage of this technique is a slightly longer procedure and the presence of an extra scar.