PMC4878252_01
A 46-year-old nulliparous female (body mass index, 17.2 kg/m2; bra cup size, E) presented with ductal carcinoma in situ of the right breast
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F1
SIEA flap harvesting [Figure 1]. She had planned for a future pregnancy with natural childbirth.
Pre-operative computed tomography-angiography showed poor visualisation of the large gluteal perforators, but alternate detection of the L2, L3 and L4 large lumbar artery perforators
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F2
Pre-operative computed tomography-angiography showed poor visualisation of the large gluteal perforators [Figure 2].
(a) A horizontal fusiform skin paddle of lumbar artery perforator flap was incised first, and then the adipose lobe that included the flap was extended both superiorly and more inferiorly to obtain the required volume of transferrable tissue, (b) from among the 3 (L2, L3 and L4) lumbar artery perforators, the L2 was the largest and ran both obliquely and deeply towards its origin between the erector spinae and the quadratus lumborum muscles
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F3
A horizontal fusiform skin paddle measuring 6.0 cm x 16.5 cm of the right LAP flap was incised and then the adipose lobe including the flap was extended both superiorly and more inferiorly to obtain the required volume of transferrable tissue [Figure 3a]. Among these vessels, the L2 LAP was the largest and ran obliquely and deeply towards its origin, which was advantageous for microsurgical anastomosis [Figure 3b].
(a) Selection of the lateral thoracic vessel as the recipient vessel with a vein interposition graft facilitating the revascularisation of lumbar artery perforator flap, (b) a schematic presentation of microsurgical anastomosis, with vein interposition grafting from the remnant lateral thoracic vein to resolve the short arterial length and the size discrepancy between the recipient and pedicle
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F4
We used a remnant of the lateral thoracic vein as an interposition graft to adjust for discrepancy in arterial length and size between the lateral thoracic artery and pedicle artery [Figure 4a and b].
(a) Post-operative view of the reconstructed breast 6 months after surgery, (b) post-operative view of the donor site 6 months after surgery
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F5
The patient's post-operative course was uneventful [Figure 5a and b].