title: Islanded pedicled superior epigastric artery perforator flaps for bilateral breast augmentation with mastopexy after massive weight loss.
abstract: OBJECTIVE
  To present a surgical technique of recruiting tissue from the abdominal wall, based on the superior epigastric artery perforators, in order to provide autologous augmentation of the breasts with mastopexy in patients after massive weight loss.
  
  
  METHODS
  A 39-year-old woman presented to the plastic surgery outpatient clinic with significant bilateral breast deformity following massive weight loss of 85.5 kg. She was dissatisfied with the appearance of her breasts and abdomen despite previous Fleur-de-lis abdominoplasty. On examination, the patient had major ptosis with a deflated breast skin envelope and near-total absence of breast volume. She had insignificant brachial skin excess and limited excess of the lateral chest wall. There was a large element of residual skin redundancy in her upper abdomen.
  
  
  METHODS
  Bilaterally, islanded superior epigastric artery perforator flaps were harvested from the epigastric region. In addition, turnover flaps were raised from the lateral chest wall. Inferior pedicled mastopexy was performed and the flaps were secured to the anterior chest wall in order to augment the breasts.
  
  
  CONCLUSIONS
  The islanded pedicled superior epigastric artery perforator flap is a useful technique for utilising the upper epigastric abdominal excess to augment the breasts following previous massive weight loss, obviating the need for implants and therefore eliminating potential implant-related complications.
authors.affiliation: Department of Plastic and Reconstructive Surgery, St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP, UK. szychta@yahoo.pl
authors.forename: P
authors.initials: P
authors.lastname: Szychta
authors.forename: W D
authors.initials: WD
authors.lastname: Anderson
mesh_terms: D000328:Adult; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D020858:Tissue and Organ Harvesting / Q000379:methods*; D015431:Weight Loss