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Open AccessArticle
The Local Rhombus-Shaped Flap—An Easy and Reliable Technique for Oncoplastic Breast Cancer Surgery and Defect Closure in Breast and Axilla
by
Hisham Fansa
Hisham Fansa
Hisham Fansa obtained his medical degree in 1994 from the Hanover Medical School in Germany. In 1995 [...]
Hisham Fansa obtained his medical degree in 1994 from the Hanover Medical School in Germany. In 1995 he received his medical doctorate. He has been the Head of Plastic Surgery at Zollikerberg Hospital since 2019 and the Head of the BreastCentre Zurich, Zollikerberg site since 2020. He is currently the Clinical Director of the BreastCentre Zurich, Bethanien & Zollikerberg. He is a member of the German and Swiss Society for Senology, of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), and the Swiss Society for Plastic, Reconstructive and Aesthetic Surgery (SGPRAEC). His work interests include breast cancer surgery and breast reconstruction with autologous tissue and implants, aesthetic facial surgery (in particular face and neck lifts and eyelids), aesthetic surgery of the breast and body and reconstructive microsurgery.
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and
Sora Linder
Sora Linder
Sora Linder is a consultant Plastic Surgeon at the Dpt. for Plastic surgery and BreastCentre Zurich, [...]
Sora Linder is a consultant Plastic Surgeon at the Dpt. for Plastic surgery and BreastCentre Zurich, Bethanien & Zollikerberg. She graduated from the Hanover Medical School in 2000 and obtained her FMH title for plastic, reconstructive and aesthetic surgery in 2008. From 2009 to 2011, she was a visiting doctor at the Royal Free Hospital, Esthetic Fellowship Wellington Hospital, London, UK. Since 2020, she has been the Head Physician of Plastic Surgery at Zollikerberg Hospital. She is a member of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the Swiss Society for Plastic, Reconstructive and Aesthetic Surgery (SGPRAEC) and the Swedish Society for Plastic Surgery (SPKF). Her work interests include surgical treatment of skin tumors, body contouring surgery/tightening/liposuction/autologous fat treatment, soft tissue reconstruction after infection, accident or chronic wounds and Intimate surgery.
Department of Plastic Surgery and Breast Center Zürich, Spital Zollikerberg, Zollikerberg, 8125 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
Submission received: 6 August 2024
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Revised: 28 August 2024
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Accepted: 5 September 2024
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Published: 6 September 2024
Simple Summary
Breast-conserving therapy to resect only the tumor in breast cancer is a standard procedure. To replace loss of volume in the breast and to avoid dislocation of the nipple/areola, local flaps are useful. One technique that has only rarely been used is the local, pedicled rhombus-shaped flap, according to Limberg. The flap is easy and safe, and the donor site is always closed primarily. On the breast, the rhombus-shaped flap can be used as an all-layer flap to cover defects, or it can be deepithelialized to be used as a buried flap. The flap can be harvested from the breast itself or the chest wall. Especially in the lateral breast, the flap is very useful. In the axilla, it can be used to cover full-thickness defects after resection when skin is involved, avoiding a contracture in the axilla.
Abstract
Primarily, breast-conserving therapy is an oncological intervention, but eventually it is judged by its cosmetic result. Remaining cavities from tumor resection can promote seromas, delay healing and cause lasting discomfort. Additionally, volume loss, dislocation of nipple/areola and fat necrosis lead to (cosmetically) unfavorable results, aggravated by radiotherapy. Oncoplastic surgery can reduce these sequelae. A local flap that has rarely been used in breast cancer surgery is the Limberg rhombic flap. The tumor defect is planned as a rhombus. The sides of the rhombus are of equal length and ideally have an angle of 60° and 120°. The flap that closes the defect is planned as an extension of equal length of the short diagonal. The second incision of the flap is placed according to the defect angle of 60°, running parallel to the defect at the same length. This creates a second rhombus. The flap is transposed into the defect, and the donor area is primarily closed. It is axially perfused and safe with a 1:1 length-to-width ratio. Compared to local perforator flaps, defect closure is easily managed without microsurgical skills. In the breast, the flap can be used in volume replacement and volume displacement techniques as an all-layer flap to cover defects, or it can be deepithelialized and buried. In the axilla, it can cover full-thickness defects when skin is involved. The advantages of the rhombic flap are its safety and simplicity to add volume and close defects, thus reducing the complexity of oncoplastic surgery.
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MDPI and ACS Style
Fansa, H.; Linder, S.
The Local Rhombus-Shaped Flap—An Easy and Reliable Technique for Oncoplastic Breast Cancer Surgery and Defect Closure in Breast and Axilla. Cancers 2024, 16, 3101.
https://doi.org/10.3390/cancers16173101
AMA Style
Fansa H, Linder S.
The Local Rhombus-Shaped Flap—An Easy and Reliable Technique for Oncoplastic Breast Cancer Surgery and Defect Closure in Breast and Axilla. Cancers. 2024; 16(17):3101.
https://doi.org/10.3390/cancers16173101
Chicago/Turabian Style
Fansa, Hisham, and Sora Linder.
2024. "The Local Rhombus-Shaped Flap—An Easy and Reliable Technique for Oncoplastic Breast Cancer Surgery and Defect Closure in Breast and Axilla" Cancers 16, no. 17: 3101.
https://doi.org/10.3390/cancers16173101
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