Volume replacement with random flaps after local breast resection

Local flaps have been used mainly to resolve the complications of breast conservative surgery and have recently been implemented as a volume replacement technique in oncoplastic surgery. These skin flaps are classified as axial and random according to the origin of their vascular supply. Axial flaps depend on an arterial pedicle at its base, and their design depends on the direction and length of the vessel, requiring identification and dissection of the pedicle. Random flaps lack a specific arterial pedicle, and their viability depends on a perforating artery and the vascular connections of the subdermal plexus. The vascular principle of these local flaps is that their length should not exceed twice that of the base, although a number of authors have disagreed with this axiom.