Free Abdominoplasty Flap for Breast Reconstruction

The first use of a
Free Abdominoplasty Flap
in Breast Reconstruction

Last year marked the 40th anniversary of the first use of a microvascular free abdominoplasty flap used in breast reconstruction.

The real story of this pioneering surgery has been hidden for decades.

Dr Richard Hamilton, who was involved in both the research and surgery at the time, is correcting history by acknowledging the ground-breaking work done in Australia and Sweden, particularly by Dr Ingemar Fogdestam.

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Watch Short Version of Video: Dr Richard Hamilton provides the history of the use of abdominoplasty flap used in breast reconstruction, pioneered by Australia and Sweden.

The Real Story

Incorrectly attributed at the time, the resources and expertise behind this breakthrough were surgeons from Australia and Sweden.

Microsurgeon Dr Ingemar Fogdestam (back to camera) performs the pioneering operation in December 1978 assisted by Dr Claes Lauritzen. (Photograph by co-micro surgeon on the case Dr Richard Hamilton)

Dr Ingemar Fogdestam and Dr Richard Hamilton

Lifting a flap; the deep inferior epigastric vessel is clearly visible (photograph by Richard Hamilton)

Richard Hamilton performing microsurgery at Sahlgrenska Hospital assisted by Ingemar Fogdestam (extreme right, hidden by the operating microscope), while Hans Holmström (left) observes through the split-beam observation tube.

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The use of a free abdominoplasty flap changed breast reconstruction from an operation that was so taxing on patients that it was rarely carried out, to one that was so straightforward it would be routinely performed all over the world.

Following the first successful operation in 1978, the study was published in the Scandinavian Journal of Plastic Surgery under the name of the acting editor at the time, Hans Holmström. This led to Holmström alone being credited with the work.

This erased the groundbreaking contributions by those who were involved from both Australia and Sweden.

The breakthrough was actually driven and performed by Professors and Surgeons from St Vincent’s Hospital in Melbourne, Australia and Sahlgrenska University Hospital in Gothenburg, Sweden.

This included the original idea by Professor Bengt Johanson to adapt a free abdominoplasty flap to breast reconstruction following radical mastectomy; the pioneering international outreach work from Dr Bernard O’Brien; and microsurgeons Dr Ingemar Fogdestam and Dr Richard Hamilton, who conducted the research and performed the first surgery.

Professor Bengt Johanson, Head of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, 1956–1986.

Dr Bernard O’Brien, founder of the Microsurgery Research Centre which subsequently became part of St Vincent’s Hospital in Melbourne.

Richard Hamilton MBBS FRACS
Hamilton House Plastic Surgery
Adelaide, South Australia

Ingemar Fogdestam MD PhD
Associate Professor
Docent Sahlgrenska University Hospital
Gothenburg, Sweden

The Full History

You can find out more about the history of this remarkable achievement via the following resources:

Full Video:

The microvascular free abdominoplasty (DIEP) flap in breast reconstruction. The untold story of the Australian contribution.

Article:

Dual perspectives of the two microsurgeons involved in the pioneering research and first operation, Dr Ingemar Fogdestam of Sweden and Dr Richard Hamilton of Australia