Latissimus Dorsi flap enhancement by lipofilling as an immediate breast reconstruction technique for skin‐preserving mastectomy

Abstract

Aim To evaluate Latissimus Dorsi flap (LD) enhancement by lipofilling as an immediate breast reconstruction technique, for skin‐preserving mastectomy regarding oncological safety, fat graft resorption after radiotherapy, and patients' satisfaction. Patients and methods This is a prospective study that included female patients complaining of breast cancer. Patients were subjected to skin‐preserving mastectomy associated with Latissimus Dorsi flap enhancement by lipofilling using the multisite, and multilayer fat grafting technique of injection. Patients were followed up for early and late postoperative complications including recurrence. Volumetric CT was performed before and after the radiotherapy to detect the percentage of fat resorption. Postoperative patients' satisfaction was assessed using the Kyungpook National University Hospital (KNUH) Breast Reconstruction Satisfaction Questionnaire. Results The study included 25 female patients with a mean age of 36.48 ± 5.87 years. The mean period of follow‐up was 30.32 ± 5.82 months. Local recurrence was encountered in 1 patient (4%). The mean volume reduction of the injected fat graft was 27.36 ± 8.58%. Twenty‐three patients (92%) declared their satisfaction after the operation, one of them was satisfied only after she underwent a second session of lipofilling. Conclusions Skin‐preserving mastectomy with the enhancement of the LD by lipofilling for immediate reconstruction of the breast seems to be a safe and simple technique for the achievement of autologous breast reconstruction. It has an acceptance rate of locoregional recurrence and minor postoperative complications. The procedure showed high postoperative patients' satisfaction and a reasonable percentage of fat resorption as confirmed by volumetric CT imaging techniques.

Combined Endoscopy-Assisted Muscle-Sparing Latissimus Dorsi Flap Harvesting with Lipofilling Enhancement as a New Volume Replacement Technique in Breast Reconstruction

“…Regarding the postoperative patient satisfaction, the overall result of our patients including those who were satisfied 6 months postoperatively and those who were satisfied after they had another lipofilling session was 95.24%. These results are better than what was reported for conventional LD flap with AF enhancement or by endoscopy-assisted LD flap without AF enhancement [ 13 , 17 ]. Nevertheless, we have to stress that our results refer to small-sized breasts (cup size A-B) and not large breasts that may be suitable in other techniques.…”

“…In this study, after harvesting the muscle through our endoscopic-assisted technique, the main disadvantage was the small volume of the muscle compared with the conventional musculocutaneous LD flap. e mean volume of the muscle in our series was 228.76 ± 5756 ml, while Ahmed et al [13] reported that the mean volume of the LD flap was 446.40 ± 70.89 ml.…”

“…Furthermore, it increased the fat uptake and reduced the complications of injection of large amounts of fat in the narrow area. The percentage of the injected fat compared with V3 was 124.40 ± 3.97%, as compared with 106.80 ± 13.90% that was reported in the conventional musculocutaneous LD flap [ 13 ].…”

“…Our choice for the LD flap in the current study was based on the fact that it was safe and effective with good esthetic outcomes [ 13 ]. However, the main disadvantage of this technique is the donor site scar, which was the main point of concern for our patients.…”

“…In 2016, it was reported that lipofilling does not increase the risk of recurrence in a cancerous breast [ 12 ]. Furthermore, LD flap enhancement by lipofilling as an immediate breast reconstruction technique for skin-preserving mastectomy was reported to be a successful and safe technique for the achievement of autologous breast reconstruction with high postoperative patient satisfaction [ 13 ].…”