The Lateral Thoracodorsal Flap In Breast Reconstruction: A Long Term Follow Up Study

Abstract

Fifty-four patients were studied a mean of five years after their breasts had been reconstructed between 1984 and 1990 using the lateral thoracodorsal (LTD) flap in combination with either a thin shell, non-low-bleed (n = 35) or a thick shell, low bleed (n = 19) silicone gel implant. The rate of capsular contracture (Baker III-IV) was 11% in the first group and 10% in the second according to a modified Baker classification. Open capsulotomy was common in both groups of patients (15/35 in the first group and 13/19 in the second). Investigation by applanation tonometry of the capsular contracture agreed with the modified Baker classification. The cosmetic results were evaluated clinically and from photographs. Best scores were recorded for scars and ptosis in both evaluations. There were no significant differences between the general cosmetic results in the two groups. The patients graded their estimations of the final outcome of their breast reconstruction on a 10-point visual analogue scale (VAS); the mean for the first group was 8.7 and for the second 9.2. None of the patients regretted her operation and they would all recommend the procedure to another patient.

Defining the Relationship Between Pocket and Breast Implant Surface Area as the Basis for a New Classification System for Capsular Contracture

“…Techniques such as applanation tonometry where a flat, clear, weighted disk is placed on the breast in an attempt to quantitatively assess the ability of the breast to deform under pressure have been des cribed. 18,46,48,51,[68][69][70][71][72][73][74][75] In a similar fashion, indentation tonometry has also been described using a weighted rod to assess the ability of the breast to deform under a measured force. 76 In addition, attempts to quantify breast firmness using calipers, either as a static measurement with the breast under pressure, or measuring breast compliance with specially designed calipers that measure compressibility of the breast under increasing pressure application, have also been reported.…”

“…Perhaps the most significant major impediment to interpreting the literature regarding capsular contracture has been the fact that the actual variable that is changing has not been adequately described or studied. The well-accepted Baker grade classification, and all of the variations that have been proposed, [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] is an "end result" evaluation technique that attempts to describe how the breast appears and feels based on a subjective assessment of resistance to compression. These classifications are based on the premise that the fixed volume of the implant has become so compressed that further external pressure exceeds the ability of the implant to deform, resulting in a palpable sense of firmness to the breast.…”

“…The presence of pain is also listed as the determining factor in identifying the highest Baker grade, with the implication being that this represents the end result and worst-case scenario of the capsular contracture process (Table 1). Although the descriptive elements of the four grades of capsular contracture have been slightly altered since the original description relating not only to breast augmentation [44][45][46][47][48][49][50] but also to breast reconstruction with and without postoperative radiation therapy, 42,[51][52][53][54] this system remains as a widely used clinical tool for describing capsular contracture and, almost universally, every publication in the literature uses some form of it to evaluate the effectiveness of whatever intervention is being studied. (See Appendix for Tables, Supplemental Digital Content 1 through 10.…”

The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

“…We modified the LICAP flap design as compared with the description by Lossing et al 25 In our hands, the combination of the original flap outline and a free abdominal flap resulted in an unsightly box-form appearance of the new breast (Fig. 3 ).…”

Thoracoabdominal Flaps for Breast Reconstruction: Different Types and Classification

“…The use of this lateral pedicle thoracoabdominal flap has had numerous publications in Scandinavian countries, where there are several publications [6][7][8]. In Latin America, although is less widespread, there are works published such as Pontes [9] from Brazil, Carriquiri [10] from Uruguay, and Fullana Sastre from Barcelona [11].…”