No abstract

Delayed breast reconstruction after irradiated mastectomy cases includes a large series of reconstructive procedures like silicone implant/expander, numerous flaps or combined methods. Bad status of irradiated tissues needs to find a way to ensure a stable breast feature. Latissimus dorsi myocutaneous flap with implant represents one of classical methods of breast reconstruction providing a new breast with superior appearance. The aim of this paper is to present the advantages of breast reconstruction with latissimus dorsi flap and silicone-filled implant. New breast is created by combining the silicone implant placed under pectoralis major muscle and latissimus dorsi myocutaneous flap. Markings of flap is performed with the patients in standing position; first the new inframammary fold and midline and on back the skin paddle is design after a pinch test to check the amount available and the future donor site closure. It is recommended to place the incisions in transverse position so that the scar to be hidden in bra line. The study includes 84 patients who underwent breast reconstruction from April 2014 to April 2016. 57 were latissimus dorsi flap with implant and 5 from which were for salvage another breast reconstruction. The patient’s age was average between 32 and 69 years. The implants used were round shape implants, silicone filled with micro-textured shell. Combination between autologous tissue and implant offer superior appearance of new breast with shape, volume, natural ptosis and consistency similar with normal breast. Also, fast recovering and socio-professional reintegration are the benefits of this method. Analyzing different surgical option, breast reconstruction with latissimusdorsi flap and silicone implant seems to offer very good results with minimum complications in such difficult cases. This method can be suitable for almost all irradiated postmastectomy cases.

The current paper is a retrospective cohort study conducted on sixty-seven patients who underwent two-stage breast reconstruction over a 5-year period (2015–2020). Forty-one (61.2%) patients received radiotherapy (RT group), and twenty-six (38.8%) did not (non-RT group). Data regarding patients, oncological therapies, type of reconstruction, time of hospitalization, complications, and costs were collected. The statistical analysis was performed using IBM SPSS Statistics 25. General complications were noted for 18 patients (43.9%) in the RT group and for 7 patients (26.9%) in the non-RT group. Major complications were observed only in the first group (five patients–12.2%). The mean time of hospitalization in the RT group was 14.83 days for patients with complications versus 9.83 days for those without complications and 15.5 days versus 8.63 days, respectively, in the non-RT group. The mean cost for patients without complications was 235.64 euros, whereas the cost for patients with complications was 330.24 euros (p = 0.001). Radiation therapy can affect the overall outcome by increasing the risk of complications and increasing costs; however, our paper shows that the association of alloplastic reconstruction in patients with radiotherapy can be performed safely and with low costs in carefully selected patients.