Creation of a Central Under Flap Pocket Allows Secondary Implant Augmentation of Perforator Flap Breast Reconstruction

What is it about?

When a single perforator flap does not provided adequate volume or projection for satisfactory breast reconstruction the addition of an implant may be considered at the time of second stage revisions. Dissection of an implant pocket beneath the flap may lead to the inadvertent injury of the flap pedicle as the tissue planes have been obscured by tissue ingrowth. The authors present a technique, the C-CUP, or Creation of a Central Under-flap Pocket technique, in which the boundaries of the implant pocket are predetermined at the time of initial flap inset using an acellular dermal matrix (ADM) construct. This allows an implant to be safely inserted at the second stage and positioned as medially as possible creating maximum projection with greater ease of dissection and minimal risk to the flap pedicle.

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