28618 – RECONSTRUCTION WITH A PLUG-FLAP BASED ON THE LATERAL INTERCOSTAL PERFORATING ARTERY

Abstract

Introduction: Currently, it is understood that routine skin resection over the tumor is unnecessary unless the skin is
involved. When required, depending on the affected region, oncoplastic techniques are used to restore the shape, volume,
and symmetry of the breasts. Defects located in the lower quadrants of the breast are addressed through established mammoplasty techniques, provided there is sufficient residual volume for reconstruction. Tumors in the upper quadrants fall
outside the scope of conventional mammoplasty approaches and thus require alternative coverage methods, such as the
latissimus dorsi flap, Burow triangle reconstruction, and other geometric compensation techniques. In 1993, Brazilian
plastic surgeon José Carlos Daher described the island flap technique (“plug flap”), where a skin island remains in the flap
to cover the excised area. Methodology: This is a case report from the Mastology Department at the Hospital de Clínicas
de Porto Alegre. Conclusion: Knowledge of different oncoplastic techniques enables the mastologist to address a wide
variety of defects. The technique used here was chosen to ensure adequate coverage of the skin defect, maintain breast
symmetry, and restore lost volume. For this procedure, a skin island was marked caudal to the inframammary fold, followed by decortication of the flap’s base while preserving the skin island to cover the defect. The perforator vessels of the 5th
and 6th intercostal spaces, originating from the lateral intercostal artery, were identified. Once the pedicle was located,
an incision was made as needed until an adequate rotation arc was achieved, allowing the flap to be positioned without
compression. The flap was then rotated to shape the breast, maintaining its conical form and avoiding depressions caused
by sutures. The current state-of-the-art in breast reconstruction is grounded in well-established historical pillars, providing the foundation for refined, high-demand techniques that require artistic skill and meticulous preparation..