Adipofascial (anterior rectus sheath) flaps for breast reconstruction.

A flat breast after a subcutaneous mastectomy for removal of a foreign body tumor or a benign tumor is not acceptable for many patients. If patients do not wish to use a silicone bag implant for reconstruction, it is necessary to use autologous tissue for the reconstruction of the breast mound. The use of a latissimus dorsi myocutaneous flap or a rectus abdominis myocutaneous flap for breast reconstruction in most patients who underwent subcutaneous mastectomy is too aggressive. Free fat grafts are also generally not effective for such patients because of the absorption of the grafted fat. We developed a procedure involving a cranial-based adipofascial (anterior rectus sheath) flap from immediately below the inframammary area for breast reconstruction. The skin incision is made at the inframammary line. After extirpation of the foreign body, the inframammary skin area is undermined. A tongue-shaped flap of the fat and the anterior sheath of the rectus abdominis muscle, approximately 7 cm in length, is pulled up, gathered, and inserted to reconstruct the breast mound. We used this technique in 7 patients, and the results were satisfactory.