The "Hug Flap"

BACKGROUND: Obtaining a natural breast mound shape contributes profoundly to a symmetrical and successful outcome in breast reconstruction.

OBJECTIVES: This paper describes a new and efficient technique that enhances breast projection with natural ptosis in delayed breast reconstruction using abdominal free flaps, and compares it to the standard methods employed nowadays.

METHODS: The charts of all patients who underwent delayed breast reconstruction using free abdominal perforator flaps were reviewed between 2007-2017. Three methods of breast reconstruction were compared: undermining, de-epithelialization and the "Hug flap". In the newly described technique: the caudal mastectomy skin was de-epithelialized and then the medial and lateral thirds were undermined and folded over to cover the central part (hug flap). 570 free abdominal flaps were performed in 490 patients for delayed breast reconstruction (410 unilateral breast reconstructions and 80 bilateral reconstructions).

RESULTS: The de-epithelization technique was the most commonly used (328 cases) followed by the undermining technique (153 cases). The Hug flap technique was employed in 89 cases. The majority of Hug flaps were done in unilateral breast reconstruction. Bilateral cases were done in only 12 patients. The rate of complications and secondary corrections were analyzed and compared between the three groups. The need for additional fat grafting was significantly (p=0,003) less required in the Hug Flap group compared to the undermining and de-epithelializing groups (resp. 12% vs. 28% and 21%).

CONCLUSIONS: While all breast enhancing options can be mixed and matched based on the surgeon's preference and experience as well as each patient's needs, the Hug Flap can be considered as an adjunct tool to provide adequate flap projection and enhance breast symmetry.