From the Guidelines
Rotation flaps are indeed indicated in breast reconstruction for cancer patients, as they offer a valuable technique for reconstructing the breast after mastectomy or lumpectomy, with advantages including good tissue match, minimal donor site morbidity, and relatively straightforward surgical technique, as noted in the most recent and highest quality study available 1.
Key Points to Consider
- Rotation flaps, such as thoracodorsal artery perforator (TDAP) flaps, lateral thoracic artery perforator (LTAP) flaps, and intercostal artery perforator (ICAP) flaps, are commonly used in breast reconstruction.
- These procedures are particularly beneficial for partial breast reconstruction following breast-conserving surgery or for correcting contour deformities after previous reconstruction.
- The procedure involves identifying a suitable donor site adjacent to the breast defect, designing the flap with appropriate dimensions, elevating it while preserving its blood supply, rotating it into the defect, and securing it in place.
- Patient selection should consider factors such as defect size, tissue availability, previous surgeries, and radiation history, as emphasized in studies such as 1 and 1.
- Recovery typically involves 1-2 days of hospitalization with activity restrictions for 4-6 weeks postoperatively.
Important Considerations for Rotation Flaps
- They are generally more suitable for smaller to moderate-sized defects and may not be appropriate for total breast reconstruction in larger-breasted women.
- The use of rotation flaps in breast reconstruction can improve the quality of life for many patients, as noted in studies such as 1.
- Preoperative imaging, such as CT angiography (CTA) and MR angiography (MRA), can aid in the identification and measurement of perforator branches, ultimately improving clinical outcomes, as discussed in 1 and 1.
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for specific clinical conditions, including breast reconstruction surgery, and emphasize the importance of accurate identification and measurement of perforator branches, as noted in 1.
From the Research
Indications for Rotation Flap in Breast Reconstruction for CA
- The rotation flap approach mastectomy has been found to offer good access for mastectomy and lymphadenectomy, with post-reconstruction outcomes comparable to other published series 2.
- The technique has the potential to facilitate reconstructive results equivalent to skin-sparing mastectomy and immediate reconstruction 2.
- However, the use of rotation flaps in breast reconstruction for cancer (CA) patients is not explicitly indicated in the provided studies, which primarily focus on TRAM flaps, free flaps, and other reconstructive techniques 3, 4, 5, 6.
Alternative Reconstructive Techniques
- The TRAM flap is a common method of autogenous reconstruction, which employs the redundant excess lower abdominal tissue to create a soft, ptotic breast mound 3, 4.
- Free flaps have a well-established role in breast reconstruction after mastectomy and can be used in partial breast reconstruction, particularly for medial and inferior defects or when there is inadequate donor tissue for a pedicled flap 5.
- Recent advancements in autologous breast reconstruction have focused on minimizing invasiveness, complications, and recovery time, with techniques such as the superficial circumflex iliac artery perforator (SCIP) flap and robotic-assisted flap harvest 6.