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Gracilis Myocutaneous Free Flap in Autologous Breast Reconstruction

Vega, Stephen J. M.D.; Sandeen, Sven N. M.D.; Bossert, Ronald P. M.D.; Perrone, Anthony M.D., M.B.A., Pharm.D.; Ortiz, Luis B.S.; Herrera, Hector M.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1400-1409
doi: 10.1097/PRS.0b013e3181babb19
Breast: Original Articles

Background: The gracilis myocutaneous free flap provides an alternative for autologous breast reconstruction. It avoids abdominal donor-site morbidity, allows for a quicker recovery, provides an alternative to the thin patient with a hidden and acceptable donor site, and allows for supine positioning for harvest and inset in a timely fashion.

Methods: A retrospective review was conducted of all autogenous postmastectomy reconstructions performed between January of 2005 and March of 2008. All patients receiving gracilis myocutaneous flap reconstruction for postmastectomy defects were included in this study. Office and hospital charts were reviewed.

Results: Twenty-seven gracilis flaps were performed during the study period. Average patient age was 50.4 years (range, 35 to 63.4 years), and average body mass index was 25.6 (range, 19.4 to 35.5). Of the 21 patients, 9.5 percent had hypertension, 19 percent smoked, none were diabetic, 14 percent were obese, and 4.8 percent had documented cardiovascular disease. Outcomes included a flap success rate of 100 percent, average operating time of 4.9 hours for unilateral (15 patients) and 6.7 hours for bilateral (six patients) flaps, intraoperative arterial thrombosis rate of 13.6 percent, average hospital stay of 3.75 days, major complication rate of 7.4 percent, and average follow-up of 7 months.

Conclusions: The gracilis myocutaneous free flap provides an alternative breast reconstruction option for today’s breast cancer patient. It allows for a quick harvest in the supine setting, creation of a moderate breast volume, consistent anatomy, and acceptable donor-site morbidity with good contour.

Rochester, N.Y.

From the University of Rochester.

Received for publication December 23, 2008; accepted April 2, 2009.

Presented at the Northeastern Society of Plastic Surgeons, in 2008.

Disclosure: No funds or other sources of financial interest were employed in supporting this work. No specific products, devices, or drugs were involved in the completion of this work. The authors have no commercial associations or financial disclosures with regard to this study that might pose or create a conflict of interest with information presented in this article.

Stephen J. Vega, M.D., 1050 Pittsford-Victor Road, Building B, Pittsford, N.Y. 14534,

©2009American Society of Plastic Surgeons