Autologous Latissimus Breast Reconstruction: A 3-Year Clinical Experience with 100 Patients

Abstract

This article presents our technique of autologous breast reconstruction using the latissimus dorsi flap and studies the advantages, disadvantages, and results that can be expected. A consecutive sample of 100 patients was studied. The average length of follow-up was 20 months (range 8 to 44 months), and all of the subjects were reviewed in consultation without loss to follow-up. The supplementary volume of the latissimus dorsi was obtained from five fatty zones: fat on the cutaneous paddle, fat taken from the surface of the muscle, the scapular fat pad, the anterior fatty zone, and the supra-iliac fat pad. This technique must be measured against the transverse rectus abdominis muscle (TRAM) flap, free or pedicled, when the patient needs an autologous breast reconstruction. It can be used when the TRAM flap is contraindicated (this corresponds to 45 percent of patients of our sample) or when the dorsal donor site is preferred (55 percent of cases of our sample). The major complications are rare (1 percent partial necrosis and 1 percent total necrosis of the flap). The minor complications are represented mainly by the dorsal seroma. This is the main drawback of the technique, as it occurs in 79 percent of cases and regularly in obese patients. In view of this frequency, patients should be warned of its likely occurrence. The dorsal donor-site morbidity is relatively low; 4 percent of dorsal sequelae were classed as moderate, and 96 percent were considered low. The scapular sequelae have been classed as low in 97 percent of cases, and temporary scapular sequelae aggravation has been noted in 3 percent. Results of breast reconstruction using this technique are most encouraging. The level of patient satisfaction is high; 87 percent of them were deeply satisfied, 10 percent were satisfied, and only 3 percent were poorly satisfied. This group of poorly satisfied subjects (3 percent) consists of patients who suffered a serious postoperative complication. The aesthetic results have been judged excellent by surgeons in 85 percent of the cases, good in 12 percent of the cases, and poor in 3 percent of the cases; no result has been judged bad. This technique of breast reconstruction by autologous latissimus dorsi brings a major advance in breast reconstruction. The best indications of this technique are when one can bury the cutaneous paddle: cases of skin-sparing mastectomy, cases where the latissimus dorsi flap can be combined with an abdominal advancement flap, and cases of conversion of implant reconstruction to an autologous reconstruction.

Sentinel lymph node biopsy in breast cancer patients undergoing skin/nipple-sparing mastectomy and immediate autologous reconstruction

“…The LDM flap is becoming increasingly popular as a reconstructive technique. This technique involves transposition of muscle from the back to the anterior chest wall and medial fixation near the sternum, preserving native nerve and blood supply (25,26). This may represent the most difficult surgical environment for a return to the axilla, since a reversal of the flap is required during ALND.…”

Thoracic Reconstruction

“…A disadvantage of the latissimus is that the patient may need to be repositioned into this position intraoperatively for flap harvest. Donor site seroma rates are also very high, with one series reporting a 79% seroma rate, and donor site incision dehiscence rates are approximately 3% [60,61]. The harvest places a conspicous scar on the back, may leave a contour irregularity, and may require a skin graft for coverage of the donor site.…”

Evaluation of quality of life after breast reconstruction using an autologous latissimus dorsi myocutaneous flap

“…The mean score in our population was 3.36 [0][1][2][3][4][5]. Age (p=0.6116), BMI (p=0.4343), the severity of complications (p=0.0765), a history of an earlier lumpectomy (p=0.911), the type of reconstruction (p=0.…”

“…The indications and the esthetic results are now well known (1). The principal aim of this so-called reconstructive surgery is not only to improve the woman's body image, but also indirectly her health-related quality of life in its physical, social, psychic and sexual dimensions.…”