Breast reconstruction through autologous flaps following mastectomy in breast cancer patients: a case series

Abstract

Introduction: Breast reconstruction for breast cancer has evolved to be associated with a health function through autologous flaps and an aesthetic benefit of applying breast implants. However, health function is preferred in developing countries, including Indonesia. Consequently, the breast reconstruction selection focuses on the autologous flap, where the transplant flaps are taken from the patient body.

Objective: This study reports four types of autologous flaps often performed in the Oncology Department of Hasanuddin University Academic Hospital, Makassar, Indonesia. The four flaps are Transverse Rectus Abdominal Myocutaneus (TRAM); Lattisimus Dorsi (LD); Horseshoe; and Thoracoabdominal (TA).  We report those cases related to each flap surgical technique and the advantages and disadvantages.

Methodology: This study is a case series of four autologous flap procedures on breast reconstruction of breast cancer patients: TRAM, LD, Horseshoe, and TA flaps. The case series is supported by a literature review regarding the related flap reconstruction studies published within the last 5 years (2018-2023).

Results: Four female patients with locally advanced breast cancer underwent breast reconstruction through four different types of flaps: TRAM, LD, Horseshoe, and TA. Pathological diagnosis revealed invasive mammary carcinoma in 3 patients and invasive ductal mammary carcinoma in 1 patient. The procedures were pedicle regional flaps without vascular anastomosis immediately after mastectomy. The four flaps did not provide any significant complications. A year post-surgery, patients are able to do activities. The post-reconstructive wounds have adequate vascularity and create a flat, good aesthetic shape, yet they are not symmetrical with the contralateral breast.

Conclusion: Each procedure has a different feasibility level, advantages, and disadvantages. These four flaps are an excellent and reliable choice for breast reconstruction in advanced breast cancer patients.