The Contralateral Breast Flap in Autologous Breast Reconstruction

The use of a contralateral breast flap is an old and sometimes overlooked surgical resource for autologous breast reconstruction in patients in which the opposite breast will need to be reduced due to breast hypertrophy and ptosis.

The aim of this study is to present our experience with breast sharing technique in three patients during a period of 5 years.

The single staged procedure was originally described by Pontes in 1973 as a breast reconstruction technique obtained from the hemipartition of the donor breast in a transversal fashion and rotated 180º in an anticlockwise direction to obtain a split breast perforator flap.

In this technique the contralateral breast is split exactly in half in a vertical fashion. The obtained flap is rotated 90º, with an axial pattern of vascularization based on perforating vessels of the internal mammary artery. Branches of the lateral thoracic artery nourish the remaining breast. In both flaps, a conical shape is obtained performing deepitheñizñisation of the ABC triangle and then approximating the points B and C.

The nipple-areolar complex(NAC) of the donating breast is reconstructed by a NAC free grafting during the same surgical stage on the original description. In our cases we preferred to delay this step for a second stage under local anesthesia.

With the single staged technique proposed by Pontes, flap congestion or failure are rare situations due to the limited torsion of the pedicle and robust blood supply. No fat necrosis was detected in our patients. The main limitation of this procedure is symmastia that appears as a consequence of split flap transposition and can be usually be corrected at the moment of NAC reconstruction by liposuction of the midline.

As with many other plastic surgery procedures, indication is critical. Ideal candidates for breast bi-partition technique are elderly women who have a large and ptotic contralateral breast that are not good candidates for a microsurgical reconstruction and do not accept the additional scars associated to other autologous reconstructive methods. On the other hand, in patients with family history of breast cancer or positive BRCA mutations this procedure should be avoided as breast cancer screening may be hindered.