Using “love handles” for breast reconstruction: no

When breast implants are not used, it is common to reconstruct breasts out of skin and fat from the abdominal region. However, thin and athletic cancer patients who had mastectomy (cancerous breasts removed) do not have much fat in that area. But they do have deposited fat on the their midsection, that layer of fat between the hip and waist called “love handles.”

Surgeons from the Johns Hopkins University School of Medicine uncovered this use of the love handles when, while doing a gluteal (buttocks) flap, they noticed a blood vessel underneath the buttocks -- the lateral septocutaneous branch of the superior gluteal artery (LSGAP). The superior gluteal artery perforator (SGAP) is the blood supply of the gluteus muscles.

Although the SGAP flap is the traditional alternative to the abdominal flap, it is an unpopular choice. Gluteal flap flattens out the buttocks, often requiring follow-up surgery to restore its usual rounded shape. And the SGAP is short in length, making it difficult to connect to the blood vessels in the chest.

Dissecting cadavers and using CT scans, the team saw that the branch artery was present in 60 percent of patients. They later performed breast surgery using the LSGAP in 12 patients at Johns Hopkins over a year period (February 2008 to February 2009). The procedure used a flap of skin and fat from the love handle region and tied up its LSGAP to the mammary blood vessel.

They found that the love handle’s LSGAP was twice as long as the SGAP, making it easier to connect the blood vessels of the flap and the recipient site. “That made the new surgery less complicated to perform,” says lead author Ariel N. Rad, MD, PhD, an assistant professor of cosmetic surgery and plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.

All of the12 breast procedures were successful. The study concluded that the LSGAP procedure is advantageous and it does not compromise gluteal function.

Rad, however, noted that not every thin patient is a candidate for the new technique. “But in those for whom it is available, LSGAP actually improves the contour of the patient's waist and hip area,” he said.

“If you’re not a candidate for an abdominal flap and you want to use your own tissue, you’re not without options,” he added. “This is a refinement of previously deforming surgery.”, 2011.