J Breast Cancer.  2013 Jun;16(2):236-243. 10.4048/jbc.2013.16.2.236.

Abdominal Advancement Flap as Oncoplastic Breast Conservation: Report of Seven Cases and Their Cosmetic Results

• Ogawa T
• Hanamura N
• Yamashita
• Ito M
• Kimura H
• Nakamura T
• Kashikura
• Nohara Y
• Noro A

• KMID: 2286407
• DOI: http://doi.org/10.4048/jbc.2013.16.2.236

Abstract

An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up and creates the shape of the inferior portion of the breast by making a neo-inframammary fold. Seven patients underwent remodeling using an AAF or a method combining an AAF with other volume displacement techniques after partial mastectomy. The excision volume ranged from 15% to 35%. AAF with only mobilization of the gland flaps was performed in two cases, with lateral mammoplasty in one case, with the round block technique (RBT) in one case, with a modified RBT in one case, and with medial mammoplasty in two cases. Although one patient treated with a RBT had a partial blood-flow insufficiency of the nipple-areola complex, it improved with conservative treatment. The cosmetic results were found to be excellent in three cases, good in three, and fair in one case.

Keyword

Mammaplasty; Operative surgical procedures; Segmental mastectomy

MeSH Terms

Breast
Cosmetics
Displacement (Psychology)
Female
Humans
Mammaplasty
Mastectomy, Segmental
Skin
Surgical Procedures, Operative
Cosmetics

Figure

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  Figure 1 The surgical procedures for using an abdominal advancement flap (AAF) combined with a lateral mammoplasty and the extended mobilization of the gland flaps (case 3). (A) Preoperative drawings. The lines mark the partial resection area, the area of the extended glandular flap, the original inframammary fold (IMF) and a neo-IMF. The skin incision line for the lateral mammoplasty was also marked. (B) After the skin incision was made and de-epithelialization was performed. (C) After remodeling the breast using an extended grandular flap. (D) Creating the neo-IMF by elevation of the AAF by applying traction on the sutures.

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  Figure 2 Photographs of case 3 taken 1 year after the operation. (A) A left oblique view with the patient in a standing position. (B) The frontal view with the patient in a standing position. (C) A right oblique view with the patient in a standing position.

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  Figure 3 The surgical procedures using an abdominal advancement flap (AAF) combined with a modified round block technique (RBT) (case 4). (A) Preoperative drawings. The lines mark the partial resection area, the original inframammary fold (IMF) and a neo-IMF. The skin incision line for the modified RBT was also marked. (B) A schematic diagram of the process of closing the defect by mobilization of the gland flaps. (C) Suturing the gland flaps to each other. (D) A schema of creating the AAF. (E) Creating the neo-IMF by elevation of the AAF by applying traction on the sutures. (F) A schema of fixation to the chest wall.

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  Figure 4 Photographs of case 4 taken 10 months after the operation. (A) A left oblique view with the patient in a standing position. (B) The frontal view with the patient in a standing position. (C) A right oblique view with the patient in a standing position.

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  Figure 5 An abdominal advancement flap used in combination with a round block technique(RBT) (case5). (A) Preoperative drawings. The lines mark the partial resection area, the original inframammary fold (IMF) and a neo-IMF. The skin incision line for the RBT was also marked. (B) The blue area is the area of skin that was resected. The purple area is the de-epithelialized area. The red area is the partial mastectomy area.

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  Figure 6 Photographs of case 5 taken 1 year and 5 months after the operation. (A) A left oblique view with the patient in a standing position. (B) The frontal view with the patient in a standing position. (C) A right oblique view with the patient in a standing position.

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  Figure 7 An abdominal advancement flap combined with a medial mammoplasty (case 7). (A) Preoperative drawings. The lines mark the partial resection area, the original inframammary fold (IMF) and a neo-IMF. The skin incision line for the medial mammoplasty was also marked. (B) Photographs taken 2 months after the operation (before reoperation). (C) After the skin incision was made and de-epithelialization was performed. (D) Creating the neo-IMF by elevation of the AAF by applying traction on the sutures. (E) The skin closure.

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  Figure 8 Photographs of case 7 taken 1 year and 3 months after the reoperation. (A) A left oblique view with the patient in a standing position. (B) The frontal view with the patient in a standing position. (C) A right oblique view with the patient in a standing position.

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