Latissimus Dorsi Breast ReconstructionLong Term Results and Return of Sensibility

Abstract

The long-term results of 44 patients who underwent breast reconstruction after mastectomy with latissimus dorsi musculocutaneous flaps with endoprostheses were studied. Good symmetry without a brassiere was achieved in 15 patients, slight asymmetry in 24 and poor symmetry in five (11%). Symmetry when a brassiere was worn was acceptable in all but one of the patients (43/44). A third of the patients (n = 13) had developed unacceptable (grade III or IV) capsular contraction, but 39 (89%) of the patients studied were satisfied with the long-term reconstruction. Cutaneous sensibility, measured by von Frey's test, had returned to 28 (64%) of the cutaneous skin islands, to their medial parts in particular. The flaps in patients who had received concentrated radiation or who had large prostheses remained numb. Sensation was normal in the scars of the donor areas in all but three patients. Latissimus dorsi breast reconstruction with an endoprosthesis is safe and simple. It gives a subjectively satisfactory result in nine out of 10 patients and is therefore a valuable method of reconstruction after mastectomy.

Assessment of postural disorders in women after radical mastectomy followed by immediate breast reconstruction

“…Wprowadzona w 1984 i udoskonalona w 1987 roku ekspandero-proteza Becker-25 składa się z dwóch komór: zewnętrznej wypełnionej stałą ilością żelu silikonowego i wewnętrznej dopełnianej w okresie pooperacyjnym roztworem fi zjologicznym soli [9,10]. Celem operacyjnej rekonstrukcji piersi jest uzyskanie dobrych efektów estetycznych, zapobieżenie niekorzystnym zmianom w psychice kobiet oraz utrzymanie prawidłowej postawy ciała po amputacji piersi [11].…”

“…Introduced in 1984 and improved in 1987, the Becker-25 expander prosthesis is composed of two chambers -the external one that is fi lled with a fi xed amount of silicone gel and the internal one that is fi lled up with physiological solution in the postoperative period [9,10]. The aim of the operative breast reconstruction is to attain satisfactory aesthetic effects, to prevent negative psychological effects and maintain correct posture after the operation [11].…”

Extension or combination of an autologous latissimus dorsi flap in breast reconstruction

“…Breast reconstructions using LD flaps with implants have the disadvantage of a capsular contracture rate of 12%Á50% [3,5,6]. To avoid implants, the extended LD was developed so that additional volume could be brought from fat deposits adjacent to the LD muscle [9,10].…”

“…This is valuable, particularly in the case of an irradiated chest wall where the rate of capsular contraction around implants rises considerably [3,4]. When the LD flap is used together with an implant on a previously irradiated patient, there is a contraction rate of 12%Á50% [3,5,6]. That is why the extended LD flap was developed as an autologous flap without an implant [7Á10].…”

Some biological characteristics of transferred free flaps

“…[4][5][6] Pain sensitivity was evaluated using Bernard's diadynamic current of 100 MHz frequency and of 1-15 mA intensity (Figs. 5 and 6).…”