Combining Autologous and Prosthetic Techniques: The Breast Reconstruction Scale Principle

Scafati, Salvatore Taglialatela; Cavaliere, Annachiara; Aceto, B.; Somma, Francesco; Cremone, L

doi:10.1097/gox.0000000000001602

Cited by 7 publications

(16 citation statements)

References 39 publications

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“…In all of our cases, patients had active physiotherapy and no long-term problems existed. Our findings agree with prior studies, which conclude that in long-term follow-up, LD harvesting does not have adversely impact on back and shoulder function 7,14 or significant loss of range of motion or movement limitations 1 …”

Section: Discussionsupporting

confidence: 93%

“…Latissimus dorsi flap is easy to harvest and is most commonly associated only with minor complications 1,6 . In this study, most complications were also minor, most commonly seroma formation.…”

Section: Discussionmentioning

confidence: 56%

“…Latissimus dorsi flap has had a resurgence in popularity mainly because of fat grafting, which enables fully autologous reconstruction even for women with bigger breasts. Traditionally, fat transfer has been used as a secondary contouring method, but an increasing number of publications considering immediate lipofilling of LD flaps have been also published 1–3,10 . In our case series, half of immediately lipofilled and 40% of implant-enhanced group required 1 additional corrective operation, usually fat transfer, but 2 corrective operations were needed seldom.…”

Section: Discussionmentioning

confidence: 73%

“…At least, lipofilling allows the implant size to be reduced, which may decrease implant-related complications over the long term. 1 It has been reported in the prior study that LD patients with lipofilling had a higher score in satisfaction than patients with implant-enhanced LD. 3 This study has several limitations.…”

Section: Discussionmentioning

confidence: 90%

“…Reconstructive surgeons have many alternative breast reconstruction techniques from which to choose the best suitable for the patient. Autologous reconstruction using abdominally based flaps is considered the mainstay, 1–3 but sometimes, abdominally based flap would not be appropriate. These cases include patients who are very thin or extreme obese or ones who have undergone abdominal contouring or multiple abdominal surgeries 4 .…”

mentioning

confidence: 99%

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Comparison of Different Techniques in Latissimus Dorsi Breast Reconstruction

2021

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Background: The latissimus dorsi (LD) flap is still a popular choice for breast reconstruction. Plain LD provides a good option for women with small breasts, but with bigger breasts, the problem is insufficient volume. Traditionally, implants have been inserted to improve the volume, but because of problems associated with them, the use of fat grafting has gained popularity. Increased numbers of reports considering also immediate lipofilling have been published. This study aimed to evaluate and compare different techniques in LD reconstruction in association with complications, number of further operations, and duration of reconstructive process. Methods: A retrospective review of patients who had undergone LD reconstruction between 2008 and 2019 was performed. Demographic and operative features, complications, and the duration of reconstruction process were analyzed. Results: A total of 291 LD flaps were performed in 283 women, including 161 (55%) implant enhanced, 73 (25%) immediate lipofilled, and 57 (20%) plain flaps. Of these, 84% were delayed reconstructions. The median volume of immediately injected fat was 155 mL (range, 50-296 mL) and inserted implant 185 mL (range, 80-420 mL). Of plain LDs, 75% did not need further operations compared with 63% of implant and 49% of lipofilling groups (P < 0.001). The median duration of reconstructive process was 10 months (range, 4-86 months) in plain, 13 months (range, 5-58 months) in implant, and 18 months (range, 5-80 months) in lipofilling group (P < 0.002). No significant differences were observed in overall complication rates between groups (P = 0.228). Most of the complications were minor, seroma being the most common. Of major complications, plain flaps were most commonly associated with donor site problems, lipofilling group with partial flap necrosis, and implant enhanced with deep infections in the breast. Shoulder problem was observed in 21 patients (7%) with no significant difference between groups (P = 0.395). Conclusions: Latissimus dorsi flap is a versatile and safe breast reconstruction method, because it is associated most commonly only with minor complications. Careful patient selection is important when choosing between different techniques. This can have an impact on the number of further operations needed and the duration of reconstruction process. Immediate lipofilling is a safe technique to avoid the use of implant and allow fully autologous reconstruction.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

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