From Defect Coverage to Microsurgical Breast Reconstruction: An Experience with Flap-Based Solutions after Mastectomy in Bangladesh
Authors: Mostakim Maria Alievna, Assistant Professor of Plastic Surgery
Institution: NIBPS
Introduction
Post-mastectomy reconstruction encompasses a spectrum of procedures, from flap coverage of the defect not suitable for primary closure to restoring breast volume. Plastic surgical techniques offer options of immediate and delayed breast reconstruction, NAC reconstruction, contralateral breast symmetrization. This experience aims to present a spectrum of flap-based reconstruction following mastectomy, including defect coverage, breast volume restoration,the initial experience with deep inferior epigastric perforator (DIEP) flaps and it highlights the evolving role of plastic surgery in post-mastectomy care in Bangladesh.
Methods
An illustrative case series was compiled using clinical photographs and available patient records. The cases demonstrate a range of pedicled and free-flap techniques, including thoracoabdominal flap,latissimus dorsi (LD) flap, axillary flap, transverse rectus abdominis myocutaneous (TRAM) flap and deep inferior epigastric perforator (DIEP) free-flap reconstruction.
Results
The cases represent diverse reconstructive objectives: coverage of defects unsuitable for primary closure, reconstruction following repeated resections for recurrent disease with chest-wall involvement, breast volume restoration using LD flaps in combination with an implant or fat grafting, NAC reconstruction, symmetrization, immediate and delayed breast reconstruction by autologous free flap (DIEP). The three DIEP cases provide an account of early experience in microsurgical breast reconstruction in our practice. Two flaps survived despite significant perioperative challenges, including intraoperative re-anastomosis in one case, postoperative flap hematoma and ecchymosis, and marginal flap and donor-site wound complications. The third flap developed failure after postoperative day four. These cases highlighted the technical demands of microsurgery and the importance of vigilant monitoring and complication management and continued team training.
Conclusion
Our experience demonstrates the complementary roles of pedicled and free flaps in a resource-constrained setting and reflects the initial development of DIEP reconstruction. Greater awareness of reconstructive options and multidisciplinary collaboration may help integrate plastic surgery more effectively into breast cancer care and expand future reconstructive opportunities.
