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The submammary adipofascial flap (SMAF) is a surgical option for the replacement of the inferior portion of the breast. It is also used to cover breast implants and is particularly useful for reconstructing partial mastectomy defects. The SMAF is based on the submammary skin crease, with the blood vessels supplying the flap originating from the superior epigastric artery and passing through the rectus abdominis muscle. The SMAF has a simple operation procedure, minimal donor site morbidity, and is considered safe due to its excellent blood supply.
| Characteristics | Values |
|---|---|
| Used for | Replacement of the inferior portion of the breast |
| Reconstruction of partial mastectomy defects | |
| Covering breast implants | |
| Correcting severe sequelae from augmentation mammaplasty | |
| Soft tissue coverage of the supraclavicular region | |
| Based on | Submammary skin crease |
| Blood vessel origin | Perforator vessels |
| Perforator vessel origin | Lateral thoracic, thoracodorsal, and intercostal vessels |
| Perforator vessel characteristics | Significantly larger, longer, and of multiple origins than those on the medial part of the flap |
| Perforator vessel function | Supplying SMAF |
| Perforator vessel diameter | 7 cm |
| Perforator vessel length | 10 cm |
| Perforator vessel length inside the flap | N/A |
| Perforator vessel distance below the submammary skin crease | N/A |
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What You'll Learn
Submammary adipofascial flap (SMAF) is used to cover breast implants
Submammary adipofascial flap (SMAF) is a valuable option for covering breast implants and replacing the inferior portion of the breast. It is a popular choice for the reconstruction of partial mastectomy defects. The SMAF is based on the cranial submammary skin crease, which is reflected back onto the breast. The flap is approximately 10 cm in length and 7 cm in width.
The blood vessels supplying the SMAF are not well-defined, and the flap's harvest may be compromised due to uncertain vascularity. The perforator vessels supplying the SMAF arise from the superior epigastric artery and pass through the rectus abdominis muscle and rectus sheath. These vessels supply the upper medial part of the SMAF. The perforators then divide into medial and lateral branches, with the lateral perforators passing into and supplying the SMAF.
The SMAF is also supplied by perforators from the internal mammary artery, which pass through the pectoralis major muscle. This provides seven branches to the SMAF, skin, and mammary gland. Additionally, the intercostal perforator supplies the lateral part of the SMAF.
The SMAF is a safe option for patients with early-stage breast carcinoma and can be used to cover implants. It is important in breast cancer therapy, occupying the area from the submammary crease to the costal margin and from the midline to the anterior axillary line. Defining the blood supply of the SMAF is crucial for appropriate flap design and to minimise the incidence of flap necrosis.
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SMAF is based on the skin crease
The Submammary Adipofascial Flap (SMAF) is a surgical technique used for the replacement of the inferior portion of the breast. It is particularly useful for reconstructing partial mastectomy defects and covering breast implants.
The Submammary Adipofascial Flap is based on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well-defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The perforator vessels supplying the SMAF are of particular interest to surgeons as they can arise from various arteries and pass through different muscles to supply the upper medial part of the SMAF. For example, the superior epigastric artery gives medial and lateral perforators, with the latter passing into and supplying the SMAF.
The SMAF outline is approximately 10 cm in length and 7 cm in width. The flap is carefully raised from below to identify the perforator vessels supplying it from all directions. These vessels are then counted, and measurements are taken to determine their diameter, total length, length inside the flap, and distance below the submammary skin crease. This information is crucial for surgical planning, especially in skin and soft-tissue reconstructive surgery, as it helps understand the histological and structural characteristics of the skin crease.
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SMAF is 10cm long and 7cm wide
The Submammary Adipofascial Flap (SMAF) is a surgical option for the replacement of the inferior portion of the breast. It is also used to cover breast implants and is particularly useful for the reconstruction of partial mastectomy defects. The SMAF is designed to be 10 cm in length and 7 cm in width. This measurement is taken from the outline of the flap, which is carefully raised to identify the perforator vessels supplying it. The blood vessels supplying the SMAF are not well-defined, and the harvest of the flap may be compromised due to uncertain vascularity.
The SMAF is based on the cranial part of the submammary skin crease, which is reflected back onto the breast. The perforator vessels supplying the SMAF arise from various arteries and pass through different muscles to supply the upper medial and lateral parts of the SMAF. For example, the superior epigastric artery gives off medial and lateral perforators, with the latter passing into and supplying the SMAF.
In one study, the SMAF was designed and dissected on both sides in 10 female cadavers. The perforator vessels supplying the SMAF were identified, and their origin, site, diameter, and length were defined. This study aimed to improve the understanding of the vascular supply to the SMAF and enhance the success rate of this surgical approach.
The Submammary Flap (SMF) is also mentioned in the context of augmentation mammaplasty. It has been used to correct severe sequelae from inadequately treated mammary implant infections. The SMF is an axial flap that can be used with a medial pedicle, based on the perforating branches of the epigastric artery. This flap technique offers a valuable solution for patients requiring breast reconstruction.
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SMAF is a valuable option for replacement of the inferior portion of the breast
Submammary Adipofascial Flap (SMAF) is a valuable option for the replacement of the inferior portion of the breast. It is a surgical approach that can be used for reconstruction in the case of partial mastectomy defects and can also be used to cover breast implants. SMAF is based on the submammary skin crease, reflecting back onto the breast.
The blood vessels supplying the SMAF flap are not well-defined, and the harvest of the flap may be compromised due to uncertain vascularity. The perforator vessels supplying the SMAF are from the superior epigastric artery and pass through the rectus abdominis muscle and rectus sheath. The perforators emerge through the rectus abdominis muscle and rectus sheath, supplying the SMAF. The SMAF procedure is easy to perform, making it possible for breast surgeons to perform it without the help of plastic surgeons.
The SMAF is supplied by local perforators from multiple sources, including the superior epigastric and internal mammary vessels, and avoids the sacrifice of muscles, skin, and large vascular pedicles. The perforators at the lateral part of the flap take origin from the lateral thoracic, thoracodorsal, and intercostal vessels. These perforators are lengthy and have a large calibre, allowing the flap to have a large rotation arc.
The SMAF is also used to correct severe cicatricial retractions and loss of the inferior pole of the breast caused by inadequately treated mammary implant infections.
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SMAF is used for reconstruction of partial mastectomy defects
The Submammary Adipofascial Flap (SMAF) is a valuable option for the replacement of the inferior portion of the breast. It is particularly useful for the reconstruction of partial mastectomy defects and is also used to cover breast implants.
Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The perforator vessels supplying the SMAF are identified, and their origin, site, diameter, and length are defined. The SMAF outline is typically 10 cm in length and 7 cm in width.
The SMAF is carefully raised from below to identify the perforator vessels supplying it from all directions. These vessels are then counted, and measurements are taken using a Vernier caliper to determine the diameter, total length, length inside the flap, and distance below the submammary skin crease. The perforators at the lateral part of the flap originate from the lateral thoracic, thoracodorsal, and intercostal vessels. These perforators are larger, longer, and of multiple origins than those on the medial part of the flap, suggesting that laterally based flaps will have better blood supply and viability.
Both medially and laterally based SMAF approaches carry a better prognosis and a lower chance of future fat necrosis than the classical cranially based flap. SMAF is also used in breast cancer therapy, which includes mastectomy with breast reconstruction using implants or musculocutaneous flaps.
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Frequently asked questions
A submammary flap is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction after a partial mastectomy or to cover breast implants.
SMAF is a type of submammary flap that is based on the cranial submammary skin crease. SMAF is used to replace the inferior portion of the breast and can be useful for reconstruction after a partial mastectomy or to cover breast implants.
A submammary flap does not include muscle. However, a short-scar pectoralis major myofascial flap can be performed through a submammary fold incision.
