Intramammarian flap reconstruction (IFR) technique in breast conserving surgery

As large segmentectomies often lead to asymmetries and indentations in the breast, numerous oncoplastic reconstruction methods have been published over the past years. Many of these involve additional skin incisions, resulting in more and larger scars.This article presents a method, which uses the same incision as for the segmentectomy and does not lead to additional scars. First, the breast gland body is being detached from the pectoralis major muscle; then the largest part of the remaining gland body is being cut horizontally parallel to the thoracic wall, exactly in the middle between the skin and the pectoralis major muscle. The pectoral part of the gland body can then be placed into the tumor bed without tension as a flap with a length of approximately 7–14 cm and a width of approximately 4–10 cm.In 2007, the first author performed a total of 134 breast conserving surgeries (9 benign and 125 malignant diagnoses) which have been prospectively documented. The intramammarian flap reconstruction technique was applied 87 times (65% of all cases), with three cases of postoperative infection and two cases needing surgical evacuation of a hematoma. In 131 cases the cosmetic results were considered favorable or moderate. The results in the 4 remaining patients were cosmetically unsatisfactory; 3 were treated with and 1 without the intramammarian flap reconstruction.In most cases the technique leads to a quick and acceptable filling of the defect and avoids nipple deviation even after a large segmentectomy, so that the breast shape can be preserved and the original breast size is being only marginally reduced.A short video demonstrates the technique on youtube and yahoo (search terms: oncoplastic, ifr)