Breast island flaps.
Breast reconstruction has been performed using neighboring skin flaps and more recently by using myocutaneous flaps. Nowadays, more conservative techniques have been proposed. Quadrantectomy combined with chemotherapy and radiotherapy offers similar survival time after treatment when compared with a more radical procedure. Techniques used by plastic surgeons for partial or total breast reconstruction have become inadequate for patients with mild breast resections. In effect, surgeons have been qualified for extensive resections, but not for small reconstructions. Lesions left after quadrantectomy become, in many situations, a difficult problem to solve aesthetically, due to the positioning of the defect in different quadrants. I describe here a new procedure that uses a breast tissue flap with its pedicle on the costal cage. Breast island flaps, also called "plug flaps," were created specifically after quadrantectomy or other types of partial breast resection, for an easier reconstruction. The anatomical basis of breast island flaps was studied in cadavers. The surgical technique and results are described and illustrated in clinical cases.