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Introduction: The 'breast-sharing' procedure uses the disposable tissue as a flap to reconstruct the post-mastectomy defect. This enables simultaneous breast reconstruction and contralateral symmetrisation without additional donor site morbidity. However, controversies related to the oncological safety of this procedure have prevented its widespread uptake. We aim to present this technique based on a pedicled internal mammary artery perforator (IMAP) flap and discuss its technical feasibility and oncological safety., Patients and Methods: Between April 2013 and May 2022, a series of 10 consecutive patients underwent a breast-sharing procedure using the pedicled IMAP flap for breast reconstruction. Clinical and surgical aspects of the breast-sharing procedure were analysed., Results: In all the cases, the breast-sharing technique allowed for simultaneous breast reconstruction and contralateral breast symmetrisation. Immediate complications included two total venous congestions and one hematoma. Three flaps had distal flap congestion. One flap required debridement and local flap reconstruction. All flaps required fat grafting during the secondary procedures to improve breast symmetry. With an average follow-up of 5.6 years, there was no evidence of recurrent disease. All patients were satisfied to very satisfied with the aesthetic outcome of this reconstructive option., Conclusions: The breast-sharing technique based on the IMAP flap combines breast reconstruction and contralateral symmetrisation with good aesthetic outcomes in selected patients. The flap has a high complication rate related to venous drainage. Flap design modification and using indocyanine green imaging may reduce venous congestion. A secondary venous micro-anastomosis at the axilla is highly recommended for persistent flap congestion. The reported incidence of contralateral breast cancer is low, and thus, the residual tissue obtained from the contralateral breast mammaplasty can be safely used for breast reconstruction., Level of Evidence: Level IV., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction., Patients and Methods: Prospective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months., Results: The reconstructed and healthy breasts decreased in volume in group 1 (-45.85 cm(3) ± 48.41 cm(3), p = 0.0004; -29.13 cm(3) ± 14.98 cm(3), p = 0.0009) and in group 2 (-31.5 cm(3) ± 25.35 cm(3), p = 0.0001; -15.4 cm(3) ± 21.96 cm(3), p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05). Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p < 0.0001), animation (p < 0.0001) and higher scores for the overall satisfaction about the reconstructed breast (p = 0.0001)., Conclusion: We suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To present a surgical technique of recruiting tissue from the abdominal wall, based on the superior epigastric artery perforators, in order to provide autologous augmentation of the breasts with mastopexy in patients after massive weight loss., Case Report: A 39-year-old woman presented to the plastic surgery outpatient clinic with significant bilateral breast deformity following massive weight loss of 85.5 kg. She was dissatisfied with the appearance of her breasts and abdomen despite previous Fleur-de-lis abdominoplasty. On examination, the patient had major ptosis with a deflated breast skin envelope and near-total absence of breast volume. She had insignificant brachial skin excess and limited excess of the lateral chest wall. There was a large element of residual skin redundancy in her upper abdomen., Surgical Technique: Bilaterally, islanded superior epigastric artery perforator flaps were harvested from the epigastric region. In addition, turnover flaps were raised from the lateral chest wall. Inferior pedicled mastopexy was performed and the flaps were secured to the anterior chest wall in order to augment the breasts., Conclusions: The islanded pedicled superior epigastric artery perforator flap is a useful technique for utilising the upper epigastric abdominal excess to augment the breasts following previous massive weight loss, obviating the need for implants and therefore eliminating potential implant-related complications., (Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background The aim of this study was to evaluate our experience with intra-operative imaging of therapeutic mammaplasty specimens at Edinburgh Breast Unit. Methods A retrospective review was performed of patients who underwent therapeutic mammaplasty in Edinburgh Breast Unit between 2007 and 2013 who had intraoperative specimen radiography. Results 98 (100%) patients who underwent therapeutic mammaplasty for breast cancer had intra-operative imaging using the faxitron ® system. 3 out of those 97 (3%) patients had a re-operation because of positive margins confirmed pathologically on cavity excision specimens, but only 1 out of 3 (1%) patients had residual breast cancer present within the re-excision specimen. None required mastectomy. Median age was 58 (range 34–81). Median follow up was 3.1 years (range 6 months – 5.5 years). There was no local recurrence or conversion to mastectomy in this group. Conclusion Complete excision rate in patients who had intra-operative imaging during therapeutic mammaplsty procedure was 97% in our group. Faxitron ® system is a useful adjunct in helping to achieve low incomplete excision rates. [ABSTRACT FROM AUTHOR]