location may lead to a major nipple-areola displacement. The combination of a large amount of scar tissue due both to tumorectomy and axillary lymph node dissection and to irradiation makes the defect too difficult to correct by mammaplasty techniques alone. In this specific case, a locoregional tissue transfer is required. Pedicled flaps from the axillary region may still be available, but pedicled latissimus dorsi, scapular, or perforator flaps might be better options for resolving this problem.
The same application of an immediate partial breast reconstruction may be used in the case of a breast deformity after conservative therapy. However, more care must be taken in using surgical techniques of mammaplasty. These cases are usually more challenging because of the irradiation's effect on the breast tissue, which leads to much less malleable and poorly vascularized tissues. The same algorithm described above in pedicle choosing can still be used (Fig. 12.5).
Nevertheless, techniques in mammaplasty should be adapted to this specific situation. A minimal skin undermining with a short and wide pedicle must be used. Experience has shown that a high rate of complications and less aesthetic results are obtained in a secondary correction compared to the immediate partial breast reconstruction. Wound dehiscence, fat necrosis, and infection are more expected in irradiated tissues, and patients who require breast correction should be aware of the potential higher risks of complications. In addition, a defect on the superoexternal
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