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Transverse Musculocutaneous Gracilis Flap for Treatment of Capsular Contracture in Tertiary Breast Reconstruction

Pülzl, Petra MD*; Huemer, Georg M. MD; Schoeller, Thomas MD

doi: 10.1097/SAP.0b013e3182933dc2
Breast Surgery

Capsular contracture is a common complication associated with implant-based breast reconstruction and augmentation leading to pain, displacement, and rupture. After capsulectomy and implant exchange, the problem often reappears.

We performed 52 deepithelialized free transverse musculocutaneous gracilis (TMG) flaps in 33 patients for tertiary breast reconstruction or augmentation of small- and medium-sized breasts. The indications for implant removal were unnatural feel and emotion of their breasts with foreign body feel, asymmetry, pain, and sensation of cold. Anyway, most of the patients did not have a severe capsular contracture deformity. The TMG flap is formed into a cone shape by bringing the tips of the ellipse together. Depending on the contralateral breast, the muscle can also be shaped in an S-form to get more projection if needed. The operating time for unilateral TMG flap breast reconstruction or augmentation was on average 3 hours and for bilateral procedure 5 hours. One patient had a secondary revision of the donor site due to disruption of the normal gluteal fold. Eighty percent of the unilateral TMG flap reconstructions had a lipofilling procedure afterward to correct small irregularities or asymmetry.

The advantages of the TMG flap such as short harvesting time, inconspicuous donor site, and the possibility of having a natural breast shape make it our first choice to treat capsular contracture after breast reconstruction and augmentation.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck; †Section of Plastic and Reconstructive Surgery, Linz General Hospital, Linz, Austria; and ‡Department of Hand-, Micro- and Reconstructive Surgery, Marienhospital Stuttgart, Stuttgart, Germany.

Received August 13, 2012, and accepted for publication, after revision, March 20, 2013.

Presented at the 49th Annual Meeting of ÖGPÄRC, 42nd Annual Meeting of DGPRÄC, and 16th Annual Meeting of VDÄPC in Innsbruck, Austria, September 29–October 1, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Petra Pülzl, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria. E-mail:

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