Volumetric change of the latissimus dorsi muscle after postoperative radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap

Abstract

Background This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy. Methods We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18 ± 4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P < 0.05. Results A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%-80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P < 0.05). All cases were observed clinically for over 3 years. Conclusions The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eL-DMC flap if the LD is thick or if it occupies a large portion of the flap.

Comparison of breast volume change between oncoplastic breast-conserving surgery with radiation therapy and a simultaneous contralateral balancing procedure through the inverted-T scar technique

“…In general, when performing balancing reduction (or mastopexy) of the contralateral breast after BCS, the affected breast is made to be slightly larger than the contralateral breast. In the procedures performed by the author, the majority of the patients showed reduced volume in both breasts more than a year after radiation therapy completion 9 . However, there were also many cases with different results.…”

“…In patients who have undergone breast reconstruction using an extended latissimus dorsi muscle flap decreased latissimus dorsi muscle mass after radiation therapy is frequently observed due to factors including muscle atrophy and fibrosis [9,10]. However, in BCS, as muscle tissue is not used for breast reconstruction, it is predicted that the amount of volume decrease would be relatively small.…”

Volumetric change of the latissimus dorsi muscle after postoperative chemotherapy and radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap: final results from serial studies

“…We also found that when patients received only POCTx after breast reconstruction using the same method, the average extent of LD atrophy at 6–14 months after chemotherapy was 62.0% [ 8 ]. Our third study showed that when patients received breast reconstruction with an eLD flap as BCS and received only PORTx, the average extent of LD atrophy at 14–22 months was 69.0% ( Table 3 ) [ 9 ]. These three earlier studies demonstrated differences in the extent of LD atrophy, providing a basis for evaluating the variance in the extent of LD flap atrophy in patients who received both POCTx and PORTx after reconstruction with an eLD flap.…”

“…However, a clinical assessment of the morphology and size of the breast through patient interviews and observations showed that minimal to no volume reduction took place more than 1 year after the completion of radiotherapy, suggesting that the results of our study are meaningful. When comparing cases using only an eLD flap with cases Without any adjuvant therapy [7] 54.5 After POCTx [8] 62.0 After PORTx [9] 69.0 After POCTx and PORTx 64.5…”

“…The authors have carried out multiple studies of volume reduction of the LD after breast reconstruction using the eLD flap, and demonstrated that the extent of LD atrophy differed between patients who received neither POCTx nor PORTx and those who received either POCTx or PORTx [7][8][9]. The average reduction of LD volume was 54.5% when receiving reconstruction with an eLD flap after total mastectomy without POCTx or PORTx, 62.0% when only POCTx was performed, and 69.0% when only PORTx was carried out.…”