LAUSR

The deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps figure among the standard techniques in delayed breast reconstruction after total mastectomy. Its scars may result in a visible bridle mainly on segment II and the external part of the breast, resulting in a constricting ring (Fig. 1A). Counteracting this bridle may require secondary intervention like Z-plasty, lipofilling, and fasciotomies to release the constricting ring. To prevent a bridle from occurring, our team performs an innovative technique in shaping this type of autologous breast reconstruction called a “Fish incision.” The technique involves performing a back-cut of 4– 6 cm in the outer and upper part of the mastectomy scar at the level of the anterior axillary pillar (Figs. 1B–1E). The back-cut is performed during the flap shaping when a bridle is visible. The constricting ring is then immediately released, thus improving the breast contour. The skin paddle of the flap is deepithelialized in order to adapt to the back-cut. The flap then takes the form of a fish with the outer area representing the tail (Figs. 1F–1H). According to Blondeel et al. ideal reconstruction must recreate a natural lazy-S shape along the lateral border of the breast between the lateral pectoral border and the lateral portion of the flap. However, in their figures, a bridle is always visible on segment II and on the external part of the breast, accessible to a simple back-cut on the anterior axillary pillar. The fishtail avoids extending the incision further than the external mastectomy scar limit, sometimes necessary to release the bridle. We performed a fish incision in 29 delayed breast reconstruction patients (5 LD flaps and 24 DIEP flaps). After a mean postoperative follow-up of 11 months, none of the patients showed any external bridle. The fishtail is a simple technique to release the external bridle, thus improving the autologous reconstructed breast contour.