Comparison of Different Techniques in Latissimus Dorsi Breast Reconstruction

Abstract

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.

Health‐Related Quality of Life After Breast Reconstruction: Comparing Outcomes Between Reconstruction Techniques Using the BREAST‐Q

“…Forty-five (31%) patients had undergone LD flap reconstruction, reflecting the popularity of this reconstruction method in Finland and Scandinavia [ 22 , 23 ]. It is considered favorable for women with small breasts or excess fat tissue in the back [ 24 ]. The LD flap has been associated with high patient satisfaction, positive aesthetic results and low complication rates [ 25 , 26 ].…”

Breast reconstruction after mastectomy in patients with obesity: a narrative review

“…However, combination of the latissimus dorsi flap with an implant may have an increased likelihood of short- and long-term risk of infection and necessity for future exchange ( 31 , 62 , 63 ). Although there have been conflicting reports ( 64 ).…”

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

“…This flap was introduced at a time when radical mastectomy involved resection of the pectoralis major muscle with remnant thin skin flaps. The LD flap not only provides optimal soft tissue and muscle replacement to enhance the new breast shape but permits adequate coverage in the use of a breast implant [ 44 ].…”

“…Non-autologous reconstruction incorporates the use of implants which may be permanent depending on the shape and volume of the breast mound desired by the patient [ 17 ], [ 18 ], [ 44 ], [ 47 ], [ 48 ]. They can be silicone or saline filled, but the former is believed to be superior in creating a soft and aesthetically pleasing breast shape.…”