THE” PLUG-FLAP”– ISLAND FLAPS OF THE BREAST

The “Plug Flap” or flaps on the breast island, described by Daher, can have different shapes and volumes, depending on the lesion resulting from the quadrantectomy, which provides great flexibility to the technique.

Breast reconstruction by plug flap after quadrantectomy. Profile view.

Plastic surgeons prepared themselves for total breast reconstructions, but they were often not prepared for partial reconstructions.

When mastologists adopted more conservative procedures that produced smaller wounds on the breast, named “quadrantectomy”, while these were much less traumatic than radical mastectomies, the simple closure resulted in distorted outcomes and were aesthetically unacceptable.

PERSONAL EXPERIENCE: I was always very dedicated to this chapter of plastic surgery, I came across a case of partial amputation, very difficult to repair, where the mastologist had removed the whole central quadrant (nipple and areola, projected in a great cylinder reaching the muscular plane in the anterior wall of the thorax).

On this day and with this case, and in a moment of divine illumination, I invented a procedure that would later change into a technique –  that aided and still aids many plastic surgeons all over the world – and has benefited hundreds of patients.

Of the contributions that I provided to Medicine, this is the one of my greatest achievements.

The Breast Island Flaps also known as “Plug-Flaps.”

This technique is applied when the mastologist removes a segment of the breast, generally attached to a segment of the skin closest to the tumor (or even without the skin fragment).

For better visualization, imagine a deep cylindrical perforation, in the shape of a bottle-neck that crosses the entire breast, from the skin to the ribs.

At this time the plastic surgeon reaches some area of the inferior pole of the breast, preferably where there is abundant or exceeding tissue, and draws and sculpts a tissue “cylinder” with skin at the top (or not, depending on the wound left by the mastologist), and this cylinder is anchored to the deep plane where arteries and veins penetrate, giving them life.

After, the surgeon will cause the free end of this cylinder to pass through the healthy tissues of the breast through a small tunnel, leading it to fill the amputated area like a cork that fits into the bottleneck or the pin of a socket that fits into its hole. This is the “PLUG”, which fits as if it were in the hole of an outlet.

After repairing the wound originated by the removal of the tumor, we have just modeled the breast in its best aesthetic form, seeking a beautiful cone, harmonious with the other breast, using the classic techniques of mammary plastic for greater harmony.

This simple technique, was based on anatomical researches on the vessels that leave the wall of the thorax.

This technique, removes the diseased area conservatively and preserves the patient’s breast almost entirety, most of the time improving its shape.

The “Plug Flap” or island flap of the breast: was a technique invented by Dr. Daher for breast reconstruction after quadrantectomy. Frontal view.