Congenital Breast Deformity Reconstruction Using Perforator Flaps

Congenital breast deformities such as tuberous breast anomaly, Poland's syndrome, amastia, and unilateral congenital hypoplasia pose a challenging plastic surgical dilemma. The majority of patients are young, healthy individuals who seek aesthetic restoration of acquired congenital breast deformities. Currently, both implant and autologous reconstructive techniques are utilized. This study detailed the authors' experience with congenital breast deformity patients who underwent reconstruction using a perforator flap.

From 1999 to 2005, a retrospective chart review was performed on women who underwent perforator flaps to correct congenital breast deformities and asymmetry. Patient age, congenital breast deformity type, perforator flap type, flap volume, recipient vessels, postoperative complications, revisions, and aesthetic results were determined.

Over a 6-year period, 12 perforator flaps were performed. All cases involved unilateral breast deformities. Patients ranged from 17 to 30 years of age. Superficial inferior epigastric artery (SIEA) flaps (n = 2) and deep inferior epigastric artery perforator (DIEP) flaps (n = 2) were used for unilateral breast hypoplasia. SIEA flap (n = 1), deep inferior epigastric artery perforator (DIEP) flaps (n = 4), and gluteal artery perforator (GAP) flaps (n = 3) were used for Poland's syndrome chest wall deformities. In all cases, the internal mammary vessels were the recipient vessels of choice. There was no flap loss. No vein grafts were used. The most common complications encountered included seroma, hematoma, and nipple malposition. Revisional surgery was performed in 30% of the cases. Aesthetic results were good to excellent.

Perforator flaps are an excellent choice for patients with congenital breast deformities seeking breast reconstruction. DIEP or SIEA flaps are the authors' choice when adequate abdominal tissue available; however, many young patients have inadequate abdominal tissue, thus the GAP flap can be utilized. The perforator flap is a safe, reliable, surgical technique. In the properly selected patient donor-site morbidity and functional compromise are minimized, postoperative pain is decreased, and excellent long-term aesthetic results can be achieved.