title: Vertically Set Sombrero-shaped Abdominal Flap for Asian Breast Reconstruction after Skin-sparing Mastectomy.
abstract: BACKGROUND
  Immediate autologous breast reconstruction after skin-sparing mastectomy is an esthetically superior method, and a free abdominal flap is often used. However, in Asian patients, little redundant abdominal skin and thin subcutaneous tissue are common, necessitating the development of a more suitable flap design and setting. We devised a narrow flap, the sombrero-shaped flap (S-flap), set vertically, to reduce postoperative abdominal morbidity without sacrificing cosmetic results.
  
  
  METHODS
  To assess this new flap design and setting, the recipient- and donor-site complications of consecutive patients treated by S-flap (n = 40) and conventional flap (C-flap) (n = 22) were retrospectively investigated. Postoperative abdominal pain, stiffness, and patient activity were also assessed in each group with our original grading scale.
  
  
  RESULTS
  Compared with the C-flap group, the S-flap group had a significantly lower skin paddle vertical height (mean, 14.0 and 10.2 cm, respectively;P< 0.001), lower abdominal stiffness (P= 0.023), and higher rate of double-pedicled flap use (27.3% and 52.5%, respectively;P< 0.048). The rates of donor and recipient site complications, postoperative abdominal pain, and activity did not significantly differ between the groups.
  
  
  CONCLUSIONS
  For immediate breast reconstruction after skin-sparing mastectomy in Asian patients, our newly designed S-flap and vertical flap setting achieved cosmetically good, consistent results with low abdominal morbidity, even though the abdominal flap was thin and narrow. The viability of the S-flap, including medial fan-shaped adipose flap, was reliable, even though the flap often required elevation with double pedicles.
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Uda
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Asahi
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Syunji
authors.initials: S
authors.lastname: Sarukawa
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Sunaga
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kamochi
authors.affiliation: Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sugawara