Outcome Analysis of Breast-Conservation Surgery and Immediate Latissimus Dorsi Flap Reconstruction in Patients with T1 to T2 Breast Cancer

Munhoz, Alexandre Mendonça; Montag, Eduardo; Fels, Klaus Werner; Arruda, Eduardo; Sturtz, Gustavo; Aldrighi, Claudia; Gemperli, Rolf; Ferreira, Marcus Castro

doi:10.1097/01.prs.0000176251.15140.36

Cited by 102 publications

(37 citation statements)

References 41 publications

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“…The most frequent complication was donor-site seroma, with a rate (17.8%) comparable to those published by Munhoz et al [16] and Kat t al [17], the seroma appeared after drain removal and required serial aspiration. This rate is not high if we take into account that all of the patients had undergone nodal dissection, this practice being a risk factor for seroma formation.…”

Section: Discussionsupporting

confidence: 65%

Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications

Fakhry¹

2015

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Abstract:Background. Use of an autologous latissimus dorsi (LD) flap in breast reconstruction accounts for a flexible and natural look of reconstructed breast and has maintained a strong popularity because of its ease of harvest, reliability, and ability to provide additional prosthetic coverage. Different complications (hematoma, seroma, flap necrosis, infection, hypertrophic scarring, and postoperative back pain) linked to this type of breast reconstruction. The aim of this study was to evaluate the complications and aesthetic outcome of (LD) flap breast reconstruction after breast cancer surgery. Materials and methods. forty patients underwent breast reconstruction using (LD) flap with a follow-up period ranged from 6 to 18 months. Patients with small to medium sized breasts underwent complete reconstruction by extended (LD) flap after mastectomy either subcutaneous or skin sparing mastectomy while patients with large pendulous breast underwent Augmentation by (LD) miniflap after conservative surgery by wide local excision (WLE) with safety margin. All patients gave their informed consent for the procedure and were aware of the potential complications and the possibility of secondary procedures. Results. The ages of the patients in our study ranged from 25 to 65 years old. 28 (70%) patients underwent (WLE) and reconstruction with (LD) miniflap while modified radical mastectomy, skin sparing mastectomy and subcutaneous mastectomy were done in 2(5%), 4(10%) and 6(15%) patients respectively with complete reconstruction by extended(LD) flap. The complication rates were noted as follows: partial flap necrosis in 4 patients (10%), wound breakdown in 2 patients (5%), lymphorrhea in 2 patients (5%), seroma in 6 patients (15%). Some of patients showed a minor deformity in the back, which disappeared with time and most patients, had temporary limitation of shoulder movements postoperatively but all recovered completely within few weeks. No patients underwent secondary nipple and areola reconstruction. No local recurrence or distant metastasis in any patient during the follow up period of our study. Evaluation of aesthetic results by patients revealed that 30 patients (75%) were deeply satisfied, 6 patients (15%) were satisfied and 4 patients (10%) were poorly satisfied. While, surgeon aesthetic evaluation was good in 28 patients (70%), satisfactory in 8 patients (20%) and fair in 4 patients (10%). Conclusion. (LD) flap breast reconstruction is a very versatile, safe and satisfactory technique with high success rate and is even suitable for high-risk patients. Donor site seroma is the most common complication and can be treated by repeated aspiration in outpatient clinic. Latissimus dorsi (LD) miniflap is the mainstay of breast reconstruction after partial mastectomy to repair defects in the lateral quadrants and the lower inner pole with low donor site morbidity and deep patient satisfaction.

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Section: Discussionsupporting

confidence: 65%

Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications

Fakhry¹

2015

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“…The use of implants positioned underneath the pectoralis muscle without concealing the upper poles of the implant under a double layer of muscle has been reported in the literature 19 . These surgeries are based on the use of the pectoralis major muscle in addition to the LDMF "in pouch," and the main concern is to provide additional protection to larger im plants to prevent skin necrosis and further complications inherent to skin-saving mastectomies.…”

Section: Discussionmentioning

confidence: 99%

Reconstrução mamária com retalho do músculo grande dorsal e materiais aloplásticos: análise de resultados e proposta de nova tática para cobertura do implante

Lamartine¹,

Júnior²,

Dahe³

et al. 2012

Rev. Bras. Cir. Plást.

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Breast reconstruction with the latissimus dorsi muscle flap and alloplastic materials: analysis of results and proposal of a new technique to cover the implant Reconstrução mamária com retalho do músculo grande dorsal e materiais aloplásticos: análise de resultados e proposta de nova tática para cobertura do implante ABSTRACT Background: Breast reconstruction is distinct among plastic surgery techniques in that it requires the integration of several medical specialties as well as coordination with the patient. The aim of the present study was to analyze the results of breast reconstruction with the latissimus dorsi myocutaneous flap, and propose a strategy for better coverage and positioning of the implant. Methods: The study included 19 patients who underwent surgery between June 2006 and June 2009. Bilateral surgery was performed in 2 patients, and a total of 21 reconstructions were analyzed. The patients filled out a questionnaire on the aesthetic and functional aspects of the reconstruction. The complications, problems, and aesthetic improvement associated with the use of implants placed under a double layer of muscle were assessed. Results: A low rate of complications was reported, and only one case required a new surgical intervention to reposition the implant in relation to the inframammary crease. After the procedure, 94% of the patients reported that their expectations had been met, 64% reported no functional limitations, and 18% reported mild limitations. The placement of implants (prostheses or expanders) under the pectoralis major muscle, using the latissimus dorsi muscle flap to cover the implant improved the breast contour by softening the inframammary crease and positioning the implants in the upper and medial quadrants of the new breasts. Conclusions: Breast reconstruction using silicone implants and the latissimus dorsi muscle flap can have excellent outcomes, with low rates of complications. Placing the implant under a double layer of muscle improves the harmony of the upper quadrants during breast reconstruction. Keywords:Mammaplasty. Breast/surgery. Breast neoplasms. Surgical flaps. RESUMO Introdução:A reconstrução mamária ocupa lugar de destaque na cirurgia plástica e exige maior doação, entrosamento e confiança entre as especialidades médicas envolvidas e a paciente. O objetivo deste trabalho é analisar os resultados das reconstruções mamárias com o músculo grande dorsal e propor uma tática para melhor cobertura e posicionamento do implante. Método: Dezenove pacientes, 2 delas submetidas a cirurgia bilateral, totalizando 21 reconstruções, foram operadas entre junho de 2006 e junho de 2009. As pacientes foram analisadas por meio de questionário sobre aspectos estéticos e funcionais da reconstrução. Foram estudadas intercorrências, complicações e melhora estética com uso do implante sob 59Breast reconstruction with the latissimus dorsi muscle flap and alloplastic materials dupla camada muscular. Resultados: O índice de complicações foi pequeno, e em apenas um caso houve necessidade de reabor...

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“…Because this flap supplies a skin paddle, it has applications for breast salvage in women with open wounds after radiation or failure of implant reconstruction. It may be used as an open technique or as a minimally invasive technique in women who have received previous radiation or in those requiring coverage after breast conservation surgery [1, 2,33].…”

Section: Latissimus Dorsi Flapmentioning

confidence: 99%

“…The choice of breast reconstruction is now considered part of early-stage breast cancer treatment not only when mastectomy is required, but more recently in women undergoing aggressive breast-conserving therapy [1,2]. Breast reconstruction offers restoration of symmetry after surgery, creating a breast mound similar in size, shape, contour, and position to the opposite breast.…”

Section: Introductionmentioning

confidence: 99%

Issues related to choice of breast reconstruction in early-stage breast cancer

O’Shaughnessy¹,

Fine²

2006

Curr. Treat. Options in Oncol.

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Reconstructive surgeons focus their efforts on refining and developing techniques that optimize oncologic outcome and recreate the most natural breast mound possible. The introduction of perforator flaps offers the potential for faster and more complete recovery, while increasing technical complexity and the risks associated with microsurgical reconstruction. Despite appealing long-lasting results, autologous reconstruction is not the ideal reconstructive choice for every patient. Tissue/expander reconstruction can produce a satisfactory aesthetic outcome and is the reconstruction of choice for most women undergoing breast reconstruction. Immediate autologous reconstruction at the time of mastectomy best resembles the lost breast and favorably withstands radiation, compared with other reconstructive methods. However, the best method for integrating reconstruction and radiation is being actively debated. Placing a tissue expander at the time of mastectomy allows a skin-sparing approach and gives the patient a chance to see how she will feel with an implant. This approach avoids radiation damage to tissue reconstruction flaps, saving them for use later if necessary. This approach, using a tissue expander as a first step, is growing in popularity.

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Outcome Analysis of Breast-Conservation Surgery and Immediate Latissimus Dorsi Flap Reconstruction in Patients with T1 to T2 Breast Cancer

Abstract: On the basis of our observations, the latissimus dorsi myocutaneous flap is a consistent technique for reconstruction following conservative breast surgery. Donor-site complications are more often observed in those who are obese; they are higher risk patients.

Cited by 102 publications

References 41 publications

Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications

Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications

Reconstrução mamária com retalho do músculo grande dorsal e materiais aloplásticos: análise de resultados e proposta de nova tática para cobertura do implante

Issues related to choice of breast reconstruction in early-stage breast cancer

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