The inferior pedicle flap used as “filler” in breast
Luiz Fernando Frascino
Received: 3 June 2012 / Accepted: 20 August 2012 /Published online: 2 October 2012
Background Oncoplastic techniques are capable of correct-
ing or preventing morphological changes of the breast un-
dergoing conservative surgery with the aim of improving the
cosmetic outcome and therefore the quality of life. Litera-
ture reports several post-conservative surgical oncoplastic
procedures using autologous or local glandular tissue.
Methods Authors report their experience with 24 breast
cancer patients (localized in upper and central quadrants).
The flap used, described by Ribeiro, is a dermal–adiposal–
glandular flap with an inferior pedicle prepared utilizing the
lower breast pole. In the six cases, we have performed an
immediate nipple reconstruction using C–V flap, sculpted
with a skin island on the Ribeiro flap, and areola tattooing.
The mean age was 56.3 years (range, 35 to 74 years), and
mean follow-up was 26 months (12 to 40 months). The level
of patient satisfaction was rated on a 1 (low) to 5 (high)
scale, before and after radiotherapy (12 months).
Results In all patients, no depression of the superior quad-
rants was noted, as well as no morphological change noted
in the “oncological” breast contour and that of the “cosmet-
ic” contralateral breast, with mean satisfaction score of 4.2.
The degree of satisfaction symmetry, assessed at 1 year from
radiotherapy, had a mean satisfaction score of 4.0.
Conclusions The use of the Ribeiro flap as a filler in appro-
priate and selected indications can represent a good alternative
to the many reconstructive methods available for partial breast
Level of Evidence: Level IV, therapeutic study.
Breast conservative therapy
Dermal–glandular local flap
Treatment of breast cancer continues to evolve, and the use of
conservative surgery has drastically increased over the years [1,
2]. In contrast to those of the past, the indications today have
been extended to larger-sized tumors and to anatomical sites
that were previously excluded from conservative surgery .
Extension of inclusion criteria, together with the oncolog-
ical need for increased local aggressiveness, has made essen-
tial the development of oncoplastic techniques capable of
correcting or preventing morphological changes in breasts
undergoing conservative surgery with the aim of improving
cosmetic outcome, therefore the quality of life . Even a
limited amount of breast removed, followed by immediate
closure of the residual glandular tissues, may result in relevant
defects with significant changes in breast contour .
The flap used, which was described by Ribeiro in 1971,
is a dermal–adiposal–glandular flap with an inferior pedicle
prepared utilizing the lower breast pole . Since conceiv-
ing the idea, and for over 30 years, the flap is used as an
autoprosthesis in reductive mammoplasty, mastopexy for
the treatment of tuberous breast, and in reconstructive surgery
in combination with inverted T or vertical techniques involv-
ing a periareolar scar [14–16]. Flap vascularization is ensured
by IV, V, and VI intercostal perforators of the internal
mammary artery .
L. F. Frascino
F. Arelli (*)
Plastic and Reconstructive Surgery Unit, Sandro Pertini Hospital,
L. F. Frascino
Department of Plastic Surgery, Hospital do Coração,
Sao José do Rio Preto, SP, Brasil
Eur J Plast Surg (2013) 36:21–26