The L-shaped combined vertical and transverse abdominal island flap for breast reconstruction.

The occasional patient will present for reconstruction after mastectomy who refuses a foreign-body implant or is desirous of reconstruction by autogenous tissue. An unfavorable midline abdominal scar that extends both below and above the umbilicus will preclude the use of the standard lower or upper transverse abdominal island flaps for such purposes. For these highly select circumstances, we present our experiences with two such patients where a combination of an L-shaped vertical and transverse rectus abdominis myocutaneous flap was employed. In this procedure, the vertical component is planned to provide the external skin cover, while the ipsilateral hemiellipse transverse component is deepithelialized and buried deep to the vertical component to provide the bulk and mound projection.