A number of myocutaneous flaps have been used in the reconstruction of the breast but only two are used on a relatively common basis:
- pedicled latissimus dorsi:
- advantages include ease of creation and reasonable recreation of bulk and contour at the time of mastectomy
- disadvantages include large scar on the back and change of contour under the arm particularly with the arm elevated
- transverse rectus abdominis:
- pedicled: the contralateral half of the rectus abdominis muscle is divided at its inferior end and swung superiorly on the superior epigastric artery
- free: the rectus abdominis muscle is harvested and the inferior epigastric vessels are anastomosed with the thoracodorsal vessels within the axilla
- better cosmetic result
- disadvantages include:
- need for microscopic and expertise during free flap transfer
- contraindicated in patients with lower abdominal scars secondary to previous operations
Flaps may be combined with other reconstructive procedures e.g. tissue expansion.