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Perforator Flaps for Breast Reconstruction

Downey, Susan E. M.D.

Plastic and Reconstructive Surgery: March 2018 - Volume 141 - Issue 3 - p 822
doi: 10.1097/PRS.0000000000004185
Book and Media Reviews

Disclosure:The author has no financial interest to disclose in relation to the content of this article.

As a service to our readers, Plastic and Reconstructive Surgery® reviews books, DVDs, practice management software, and electronic media items of educational interest to reconstructive and aesthetic surgeons. All items are copyrighted and available commercially. The Journal actively solicits information in digital format for review.

Reviewers are selected on the basis of relevant interest. Reviews are solely the opinion of the reviewer; they are usually published as submitted, with only copy editing. Plastic and Reconstructive Surgery® does not endorse or recommend any review so published. Send books, DVDs, and any other material for consideration to: Arun K. Gosain, M.D., Review Editor, Plastic and Reconstructive Surgery, Brookriver Executive Center, 8150 Brookriver Drive, Suite S-415, Dallas, Texas 75247.

Arun K. Gosain, M.D.

Review Editor

The history of breast reconstruction using autologous tissue is relatively brief—starting with Mathes and Nahai and their work classifying muscle and musculocutaneous flaps in the 1980s and really accelerating in the past 25 years. From the transverse rectus abdominis musculocutaneous flap to the eight or so perforator flaps discussed in this book is really an amazing show of the ingenuity and talent that plastic surgeons have expended in working toward better outcomes for patients undergoing breast cancer treatment. The introductory chapter by Sarah Appleton and Steven Morris describing the journey from tubed flaps to perforator flaps will encourage and inspire plastic surgeons and educate breast surgeons in the advances made in the past 25 years.

The point is well made about the advantages of a breast center offering microsurgical options for breast reconstruction. The difficulties and obstacles are well laid out in the second chapter by Vargas and Lee. Even for established programs, the key components, checklists, and intraoperative pathway described would be worth reviewing to optimize a program, and look for quality improvement opportunities. Pearls such as the suggestion in the third chapter describing essential equipment by David Greenspun to maintain a small stock of “extra” delicate microsurgical instruments might seem like an obvious suggestion but just might keep those just establishing a program from running into a long intraoperative delay or even worse.

The bulk of the book is devoted to describing the different perforator flaps currently used for breast reconstruction. The benefits and disadvantages of each of the flaps are clearly outlined and the techniques specific to the harvest and insetting of each flap are well laid out. This will be very useful for surgeons wanting to explore other options in patients who have limited donor sites. The authors do not shy away from presenting complications and recommendations to optimize outcomes.

The chapter on imaging for perforator breast reconstruction goes through all the range of possibilities with useful information on radiation exposure and recommendations for studies in patients where some of the donor sites may have been damaged during previous operations and several sites may need to be evaluated. A final chapter on indocyanine green/SPY imaging (Novadaq Technologies, Inc., Mississauga, Ontario, Canada) in perforator flap breast reconstruction by Michael Zenn will be helpful for any reconstructive breast surgeon or oncologic breast surgeon thinking of incorporating the use of the SPY system into his or her practice.

Perforator Flaps for Breast Reconstruction is a useful book for surgeons working with breast cancer patients who are looking to incorporate perforator flaps into their programs. There is practical advice and warning and realistic expectations. Even for surgeons not wanting to include microsurgical techniques, the book offers useful information on the SPY Elite system and an informative look at the history of autologous reconstruction and might inspire the consideration of including microsurgical options in their programs.

Copyright © 2018 by the American Society of Plastic Surgeons