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A Quadrant-Based Algorithm for Oncoplastic Breast Reduction: The Use of Mirror Flaps for Filling Superior Pole Mastectomy Defects
Rachel N. Rohrich
*, Nicole Episalla, Sami Ferdousian, Ryan Lin, Kenneth Fan, Samer Jabbour, Stephen Baker
Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington,
Background: Reconstructing upper quadrant defects in oncoplastic breast reduction (OBR) can be challenging due to upper pole concavity after tumor resection. To address this, we adopted a dual-component technique using two separate flaps: (1) a superiorly based flap for the nipple-areola complex (NAC) and (2) an inferior advancement flap from the quadrant ipsilateral to the lumpectomy defect, "mirroring" the laterality of the defect. This study evaluates outcomes using this algorithm for superior pole reconstruction in OBR.
Methods: A retrospective review was conducted of OBR cases performed by a single surgeon from September 2022 to November 2024. All were performed for oncologic indications and used an inferior flap for upper quadrant volume displacement according to the senior author's algorithm demonstrated in
Figure 1.
Results: A total of 47 patients (51 breasts) underwent lumpectomy and immediate OBR. Most tumors were located in the upper outer quadrant (UOQ; 70.6%), followed by the upper inner quadrant (UIQ; 29.4%). Superomedial NAC pedicles were used for UOQ defects and superolateral pedicles for UIQ. All UOQ defects were filled with inferolateral advancement flaps and all UIQ defects with inferomedial flaps. Over 13.2 ± 7.5 months of follow-up, 15.7% of breasts experienced complications. One breast (2.0%) had upper pole concavity not requiring revision. Six breasts (11.8%) underwent revision secondary to complications related to radiation (5/6) or dehiscence (1/6).
Conclusion: The proposed dual-component mirror flap technique reliably reconstructs superior quadrant defects with low rates of contour deformity.
Figure 1. The senior author's algorithm for "mirror flap" OBR. Diagrams of the breast at the bottom of the figure represent the right breast. The breast is divided into thirds, with the upper half divided into quadrants. The center yellow circle represents the NAC. Red masses represent cancer. Blue represents the NAC pedicle. Green represents the inferior advancement flap.
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