The Scarless Latissimus Dorsi Flap for Full Muscle Coverage in Device-Based Immediate Breast Reconstruction: An Autologous Alternative to Acellular Dermal Matrix

Elliott, L. Franklyn; Ghazi, Bahair H.; Otterburn, David M.

doi:10.1097/prs.0b013e318218fcc6

Cited by 29 publications

(20 citation statements)

References 23 publications

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“…Universal goals in all forms of reconstructive surgery, however, should include, wherever possible, minimizing scars, shortening operative time, and decreasing hospital stay. 23–27 This procedure has been described before 16,17 ; however, we hoped to describe clearly our personal technique that requires no endoscopic equipment and no patient repositioning and that can be performed using instruments available to all plastic surgeons around the world. This procedure enables us significant savings in operating time, with the reconstructive surgeon able to start operating with a second team after completion of the first side.…”

Section: Discussionmentioning

confidence: 99%

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The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

Lee

Miteff

2014

Plastic and Reconstructive Surgery Global Open

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Background:The evolution of surgical breast cancer treatment has led to the oncologically safe preservation of greater amounts of native skin, yet we are still often using flaps with large skin paddles, thereby resulting in significant donor-site scars. This explains the increasing appeal of acellular dermal matrix reconstructions. Acellular dermal matrices can, however, have significant problems, particularly if there is any vascular compromise of the mastectomy skin flaps. We have developed a method of raising the latissimus dorsi flap through the anterior mastectomy incisions without requiring special instruments or repositioning. This can provide autologous vascularized cover of the prosthesis.Methods:A clear surgical description of the scarless latissimus dorsi flap harvest is provided, and our results of a retrospective cohort review of 20 consecutive patients with 27 traditional latissimus dorsi breast reconstructions were compared with those of 20 consecutive patients with 30 scarless latissimus dorsi breast reconstructions.Results:Operative time, length of stay, and complication rates were reduced in the scarless group. Patients Breast-Q scores were equivalent in each group. The aesthetic assessment was good/excellent in 77% of both groups; however, subscale assessment was better in the scarless group. This was statistically significant (P = 0.0).Conclusions:Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices.

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Section: Discussionmentioning

confidence: 99%

“…This gives the security of fully vascularized coverage of the prosthesis in the event of skin necrosis. The scarless latissimus dorsi flap 16,17 can harvest a significant proportion of the latissimus dorsi using standard breast surgery instruments and without requiring endoscopic instrumentation. It has the added significant advantage of no donor scar.…”

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confidence: 99%

The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

Lee

Miteff

2014

Plastic and Reconstructive Surgery Global Open

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“…Presumably, the well-vascularized latissimus muscle used as a flap has the ability to suppress bacterial growth. 11 , 12 The impression was also that the abundance of subcutaneous fat incorporated within and immediately adjacent to the skin island provided an enhanced aesthetic result, although no objective assessment of that outcome was performed.…”

Section: Discussionmentioning

confidence: 99%

Tissue Expander versus Tissue Expander and Latissimus Flap in Morbidly Obese Breast Reconstruction Patients

Luce

Adams

Chandler

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:Immediate postmastectomy breast reconstruction in morbidly obese patients represents a challenge because neither prosthetic nor abdominal-based options may be suitable.Methods:This study compared a previously published cohort of immediate prosthetic reconstruction of 346 patients (511 breasts) of whom 49 patients (67 breasts) were morbidly obese (defined as a body mass index > 35) with a morbidly obese patient population whose breasts were reconstructed immediately following postmastectomy with latissimus flap and tissue expander (21 patients and 22 breasts) in the same time period. The preoperative risk factors of mastectomy such as tobacco use, diabetes, and prior radiation and the postoperative complications of mastectomy such as skin necrosis, seroma, and prosthesis loss were examined. The explantation of the tissue expander provided a defined endpoint of reconstruction failure.Results:The average body mass index in the tissue expander/implant group and in the latissimus flap plus tissue expander/implant group was 40.9 and 40.1, respectively. The risk profile of diabetes and tobacco use was similar in both groups. Fifteen of the 67 breasts (22.3%) of the tissue expander/implant group and 15 of the 23 breasts (65.2%) of the latissimus flap group had received prior radiation. The prosthesis loss was 13 of 67 breasts (19.4%) that had tissue-expander–alone reconstruction and 1 of 22 (4.8%) in the latissimus group that had tissue expander reconstruction. Modification of donor-site incision and skin-island location in the latissimus group of patients can minimize scar deformity.Conclusion:The loss rate in immediate postmastectomy reconstruction in morbidly obese patients with latissimus flap plus tissue expander was substantially lower than the loss rate in those with breast reconstructed with tissue expander alone.

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“…using his scarless latissimus procedure. 2 After latissimus dorsi harvest, both sides were checked for hemostasis and dried with a laparotomy sponge. One side was chosen at random to have the autologous platelet-leukocyte-enriched plasma applied according to our protocol.…”

Section: Methodsmentioning

confidence: 99%

The Use of Autologous Platelet-Leukocyte-Enriched Plasma to Minimize Drain Burden and Prevent Seroma Formation in Latissimus Dorsi Breast Reconstruction

Harper

Elliott

Bergey

2012

Annals of Plastic Surgery

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The Scarless Latissimus Dorsi Flap for Full Muscle Coverage in Device-Based Immediate Breast Reconstruction: An Autologous Alternative to Acellular Dermal Matrix

Abstract: Therapeutic, IV.(Figure is included in full-text article.).

Cited by 29 publications

References 23 publications

The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

Tissue Expander versus Tissue Expander and Latissimus Flap in Morbidly Obese Breast Reconstruction Patients

The Use of Autologous Platelet-Leukocyte-Enriched Plasma to Minimize Drain Burden and Prevent Seroma Formation in Latissimus Dorsi Breast Reconstruction

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