Alternative flaps for breast reconstruction: a narrative review on using the thigh, buttocks, and back

As the treatment of breast cancer has dramatically improved in the past decades, so have the techniques for breast reconstruction. Recent innovations in breast implants and the advent of acellular dermal matrices have expanded options for reconstructive surgeons, allowing for cosmetic results previously unattainable in selected cases. However, autologous reconstructive techniques using free flaps remain to provide results that are unparalleled in terms of durability and feel. In this narrative review, the authors share their current experience with free flaps for breast reconstruction harvested from regions other than the abdomen. These include flaps that can be harvested from the thigh, buttocks, and back regions such as upper gracilis myocutaneous flaps, the profunda artery perforator flap, the lateral thigh perforator (LTP) flap, gluteal artery perforator flaps, and the lumbar artery perforator flap. The aim of this article is to improve readers' understanding of the advantages and caveats of each flap, patient selection, and key surgical points. For those interested in learning to perform any of these flaps, a 10-step summary is provided which describes our personal technique in flap harvesting in more detail. Furthermore, knowledge gaps that exist about the clinical outcomes of each technique and future research implications are also highlighted.