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The Medial Pillar Island Flap for Oncoplastic Breast Reconstruction of Upper Pole Defects

Akyurek, Mustafa, MD, PhD*; Tomczyk, Eleanor, MD*; Albert, Mark, MD*; Quinlan, Robert, MD

doi: 10.1097/SAP.0000000000001673
Breast Surgery
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Background Breast deformity is common following lumpectomy. Use of ptotic lower pole tissue for restoration of volume in the upper pole is quite appealing since it allows for a concomitant lift. This study presents the medial pillar island flap technique of oncoplastic breast reconstruction of upper pole defects.

Methods Vascular anatomy of the lower pole of the breast was investigated with cadaver study. The medial pillar island flap was designed utilizing the territory of the inferior pole of the breast as an island flap pedicled medially by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar. It was transposed to the upper pole lumpectomy defect as an independent flap from superomedial pedicle which was utilized for nipple transposition.

Results The dominant internal mammary artery perforator supplying the medial pillar island flap was consistently found in the fourth interspace at a mean distance of 8.5 cm (range, 8 to 10) from the sternal midline. Thirty patients underwent the procedure, with a mean age of 61 years and mean body mass index of 28.9. The average size of the defect was 170 cm3 (range, 48 to 295 cm3). The majority of the patients (n = 28) underwent opposite breast symmetry surgery as well. The average follow up was 12 months. Complication rate was 23.3%. Reoperation rate was 16.7%. There was no evidence of flap compromise or nipple areola complex necrosis. Patient satisfaction was high, with a mean score of 4.1 (range, 2 to 5) out of 5.

Conclusions The medial pillar island flap has reliable vascularity based on the internal mammary artery system. The flap carries lower pole breast tissue as confined by the medial and lateral pillars of a vertical mastopexy design, offering unrestricted arc of rotation for effective reconstruction of upper pole lumpectomy defects as it is completely dissected from the chest wall and the inframammary fold. The two flap design, along with superomedial pedicle, accomplishes versatility for flap inset. The technique was proven to result in safe outcomes without major complications.

From the *Division of Plastic Surgery and

Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA.

Received May 27, 2018, and accepted for publication, after revision August 30, 2018.

The study was partly presented at the 2016 Plastic Surgery Meeting, Los Angeles, California, and the 2016 Annual Meeting of the American Association of Plastic Surgeons, New York, NY.

Conflicts of interest and sources of funding: none declared.

Reprints: Mustafa Akyurek, MD, PhD, Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA. E-mail: akyurekm@ummhc.org.

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