Breast reconstruction as staged procedure has its benefits and limitations. Following radiotherapy, implant based procedures might suffer complications accordingly. Therefore, some surgeons suggest autologous breast reconstruction surgeries. They support of this idea illustrating predictability and acceptable long term aesthetic and functional results. Among autologous breast replacement surgeries, free tissue transfers need special facility and expert surgeons who passed steeped learning curves. Thus, pedicle based flaps are generally accepted and adopted by plastic surgeons. . . .

The perfect method for breast reconstruction would be safe, reliable, reproducible, applicable to all patients, and would have no donor site morbidity. The ideal reconstructed breast would provide symmetric, permanent, and natural results. There has been development and refinement of autogenous methods of breast reconstruction throughout the literature. The TRAM flap remains the most popular method of autogenous reconstruction. This popularity is due to the relative ease with which the procedure is performed but it has its own drawbacks. Other procedures include: Deep inferior epigastric artery perforator flap; free flaps (free TRAM flap; free superior gluteal myocutaneous flap); pedicled lattisimus dorsi flap, etc. We have reconstructed the breast in ten patients after mastectomy with a different technique which is cutaneoglandular flap from the contralateral normal breast. It has the advantage of using normal breast tissue for reconstruction in addition to reduction of a possible large breast the patient may have. It is almost without donor site morbidity and there is no need to reposition the patient intraoperatively. It is mostly used when the patient is reluctant to undergo a big operation. This technique can also be used when there are contraindications to other techniques. In this paper, patients are presented who have undergone contralateral cutaneouglandular flap with an inferior pedicle and free nipple graft technique with fairly satisfactory results.

Background: The transverse rectus abdominis musculocutaneous (TRAM) flap remains the gold standard for postmastectomy reconstruction either immediate or delayed. However, transfer of TRAM flap can be associated with donor site morbidities and complications in flap. A successful reconstruction consists of careful patient selection, surgical technique and meticulous preoperative planning. This study was designed to evaluate outcome and complications of breast reconstruction with TRAM flap in association with patient conditions and risk factors, prospectively.Methods: Breast reconstruction was performed in 44 women consecutively, using the TRAM flap during a 3-year period, 1999–2002. Modified radical mastectomy accompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy.Results: The mean age of the patients was 40.41±4.43 years. Thirty (68.18%) patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAM flaps were used in 26(59.09%) and 14(31.81%) reconstructions, respectively. The abdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18%) patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%), partial flap loss (13.64%), etc. Satisfaction rates were excellent in 10 (22.72%), good in 25 (56.82%), moderate in five (11.36%), and poor in four (9.09%) patients. The mean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 in patients with contralateral and ipsilateral flaps, respectively (p>0.05). A significant association was observed between overall complications and comorbidities. Partial flap loss and fat necrosis was associated with smoking, and abdominal hernia was associated with obesity marginally.Conclusions: The outcome of breast reconstruction using TRAM flap is similar by surgical technique and time of reconstruction. The most common flap complications were fat necrosis and partial flap loss that was associated with smoking. Acceptable satisfaction is obtained by TRAM flap.

Background: Breast-conserving surgery (BCS) and post-surgical radiotherapy are the treatment of choice in early-stage breast cancers. Surgeons use different techniques for the reconstruction of the breast after BCS. We aimed to present our novel reconstruction technique for medial breast defects and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. Methods: Forty patients with medially located breast tumors under BCS referred to Shahid Modares Hospital in Tehran, Iran from 2018 to 2022 were enrolled in the study. The patients underwent breast reconstruction post-lumpectomy using the local transposition flap technique. We followed the patients for one year, and the satisfaction and complication results were assessed and reported post-operation, after radio-chemotherapy, and after one year. Results: The patients’ mean age was 48.4 (±12.3) years, and the mean BMI was 30.9 (±3.1). There were no cases of complication, including infection, seroma formation, hematoma, flap ischemia, or necrosis post-operation, one week and one month after discharge. The surgeon and patient satisfaction surveys conducted post-op, after the radio-chemotherapy course, and one year after BCS using the Breast-Q satisfaction domain showed that the excellent and good satisfaction rates are 88%, 92%, and 92%, respectively. Conclusion: Local transposition flap has remarkable cosmetic results with the least complication rate in the reconstruction of medial breast defects after breast-conserving surgery and is an excellent choice for surgeons.

Background: Finger tip injuries are one of the most common types of injury. Destruction of the skin in this area leads to destruction of sensory receptors. As hand function is closely related to sensibility of the finger tips, selecting the best procedure of reconstruction that provides the highest degree of sensation is very important. As V-Y Flap and Neurovascular Island flap are more common used, the aim of this study is comparison of these two methods for restoration of finger tip sensation.Methods: This is a clinical trial study of 70 patients with traumatic finger tip injury who were randomly divided into two groups. Finger tip injuries reconstructed by V-Y Flap were placed in group A and neurovascular Island flap in group B. Sensation of the reconstructed finger tip was checked in all patients by two point discrimination test 1 year after operation.Results: Each group was included 35 patients. Incidence of necrosis, flexion contracture and discomfort of the patients was similar in the two groups. Sensibility of the fingers was 54.8% in group A, and 93.5% in group B, which is statistically significant. (P=0.0005).Conclusion: Restoration of sensibility to the finger tip is significantly more successful by neurovascular Island flap in comparison to V-Y Flap method for finger tip reconstruction.