Unilateral Reconstruction of the Large Breast: Combining Prosthetic and Autologous Methods for Improved Symmetry

Postmastectomy reconstruction in patients with significant macromastia and/or large chest wall dimensions can be challenging. Implants have a limited size range and may not be large enough to adequately reconstruct a wide, obese patient. Abdominally based flaps may be unsafe in these patients if they have significant obesity and or other comorbidities and may still be insufficient to adequately fill a very large breast footprint. These problems are compounded in the patient who is not a candidate for an abdominal flap and who undergoes unilateral mastectomy as the contralateral breast, even after aggressive reduction, may still require volume and dimensions that cannot be easily replicated with prosthetic methods alone. Therefore, it seems reasonable to supplement our implant-based reconstructions with additional autologous tissue to reconstruct the breast after mastectomy to obtain acceptable symmetry with the large, contralateral native breast. Here, we report a case of combining the largest available anatomic implant with an extended lateral intercostal artery perforator flap to reconstruct a large breast and obtain symmetry with the native breast.