The role of the rectus abdominis myocutaneous flap in breast reconstruction.
The rectus abdominis myocutaneous flap has been used in 10 patients requiring the importation of skin, subcutaneous tissue, and muscle for postmastectomy reconstruction. It was preferred to the latissimus dorsi myocutaneous flap under the circumstances highlighted in Table I. The flap has proved reliable and easy to raise, with a consistent anatomic location of the arterial venous pedicle. In 10 such flaps performed, one partial necrosis occurred in a patient who was extremely obese and had had a previous laparotomy that may have interfered with the integrity of the underlying blood supply to the rectus abdominis muscle. A minor complication of cellulitis in the donor-site wound was due to an idiosyncratic allergy to sutures used in the subcutaneous tissue. One instance of abdominal contour deformity was noticed in a patient in whom the anterior rectus sheath had been reconstituted by advancing the fascia of the external oblique muscle to meet the linea alba in the midline. In summary, we believe that the rectus abdominis myocutaneous flap, in certain select circumstances, produces a reliable, readily accessible myocutaneous flap to import tissue to the anterior chest wall for adequate mound reconstruction after mastectomy.