Immediate breast reconstruction with thigh free dermal fat flap: a case report

Objective To explore the feasibility of breast reconstruction using thigh free dermal fat flap. Methods In January 4, 2017, a 27-year-old unmarried female patient with breast cancer was admitted to the Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University. She previously underwent breast tumor biopsy in another hospital. In our hospital, she was pathologically diagnosed as having invasive micropapillary carcinoma in the right breast with ER (+ , >90%), PR (+ , >90%), HER-2 (-), Ki67 (+ , about 30%). Preoperative ultrasound showed that the fat thickness in the inferior part of the breast was 3.0 cm and the fat thickness in internal femoral region was 4.5 cm. The patient underwent the right breast conserving surgery plus right axillary lymph node dissection plus immediate breast reconstruction using internal femoral free dermal fat flap. A 5.0 cm × 7.0 cm flap was removed from the medial proximal root of the right thigh during the operation. After de-epidermidalization, the flap was shaped and fixed on the surface of the pectoralis major muscle. Surgical specimens were sent for pathological examination and the patient was examined by breast ultrasound and MRI on postoperative days 7 and 10. Results Postoperative pathology confirmed invasive micropapillary carcinoma of the right breast. Sentinel lymph node biopsy showed metastatic carcinoma (1/2), while no metastatic carcinoma was observed in axillary lymph nodes of levels Ⅰ to Ⅲ. Postoperative ultrasound showed that the reconstructed flap had the same echo to the original subcutaneous residual adipose tissue in the right breast, without dark area of fluid, infection and ischemic necrosis, suggesting the survival of flap. The breast MRI showed that the surgical area was filled with adipose tissue and blood circulation was good. On postoperative day 2, the patient had out-of-bed activities. On postoperative day 5, two drainage tubes were removed. On postoperative day 10, the reconstructed breast had good shape, bilateral symmetry, no appearance change or discomfort in the supine position and standing position. Moreover, the scar was occult in donor area. She was satisfied with clinical outcome. She was followed up until August 31, 2017. The follow-up showed good shape and bilateral symmetry of breasts, without recurrence or metastasis of breast cancer. Conclusion The transplantation of thigh free dermal fat flap can be used as an individualized surgical method for the repair of local breast deformity after breast conserving surgery. Key words: Breast neoplasms; Surgical flaps; Mammaplasty