Chapter 5 Table 5.2 Complications DISCUSSION Most microsurgeons who perform autologous tissue breast reconstruction select the abdomen as their first choice for the donor site. We agree with this preference; we also prefer the abdomen as our primary donor site for autologous tissue breast reconstruction. Furthermore, our second-choice donor site for microsurgical breast reconstruction is the medial thigh. Like the abdomen, the medial thigh donor site does not require positioning changes during the operative procedure. The patient can remain supine for both flap harvest and inset, which minimizes the anesthesia time for the patient. Despite the advances that have been made with the S-GAP and I-GAP flaps, the buttock remains our third-choice donor site for microsurgical breast reconstruction. Unlike the abdomen and medial thigh, the buttock as a donor site for microsurgical breast reconstruction requires positioning changes for flap harvest and inset. Furthermore, the intramuscular dissection of the gluteal artery perforator can be difficult, and a significant size mismatch between the superior gluteal artery and the internal mammary artery is always a concern. As microsurgeons, however, we are committed to performing micro- surgical breast reconstruction, and there are inevitably times when our first two donor-site choices are unavailable. At this time, our preference is to use the sc-GAP flap as described in this series. We find the harvest of the sc-GAP flap to be simpler and faster than a conventional S-GAP or I-GAP harvest, because the intramuscular dissection is avoided. In addition, when the most lateral septocutaneous perforator is used, the pedicle is longer than 75
5. lay-out phd DEFINITIEF_digitaal2
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