Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications
Journal of Surgery
Volume 3, Issue 5, October 2015, Pages: 44-49
Received: Jul. 27, 2015;
Accepted: Aug. 6, 2015;
Published: Aug. 19, 2015
Views 4566 Downloads 91
Hussein Fakhry, Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Kassim Abdelazeem, Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Hesham Hamza, Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Badawy Ahmed, Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Mahmod Mostafa, Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Gamal Amira, Surgical Oncology Department, National Cancer Institute, Cairo University, Assiut, Egypt
Arwa M. Ali, Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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
Arwa M. Ali,
Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications, Journal of Surgery.
Vol. 3, No. 5,
2015, pp. 44-49.
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002, 347:1227-1232.
Munhoz AM, Aldrighi CM, Ferreira MC: Paradigms in oncoplastic breast surgery: a careful assessment of the oncological need and esthetic objective. Breast J 2007, 13:326-327.
Hamdi M, Wolfli J, Van Landuyt K: Partial mastectomy reconstruction. Clin Plast Surg 2007, 34:51-62; abstract vi.
Munhoz AM, Montag E, Arruda E, Pellarin L, Filassi JR, Piato JR, de Barros AC, Prado LC, Fonseca A, Baracat E, Ferreira MC: Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique. Plast Reconstr Surg 2008, 121:716-727.
Knight MA, Nguyen DTt, Kobayashi MR, Evans GR: Institutional review of free TRAM flap breast reconstruction. Ann Plast Surg 2006, 56:593-598.
Eriksen C, Stark B: The latissimus dorsi flap--still a valuable tool in breast reconstruction: report of 32 cases. Scand J Plast Reconstr Surg Hand Surg 2008, 42:132-137.
Noguchi M, Taniya T, Miyazaki I, Saito Y: Immediate transposition of a latissimus dorsi muscle for correcting a postquadrantectomy breast deformity in Japanese patients. Int Surg 1990, 75:166-170.
Raja MA, Straker VF, Rainsbury RM: Extending the role of breast-conserving surgery by immediate volume replacement. Br J Surg 1997, 84:101-105.
Chang DW, Barnea Y, Robb GL: Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts. Plast Reconstr Surg 2008, 122:356-362.
Delay E, Gounot N, Bouillot A, Zlatoff P, Rivoire M: Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients. Plast Reconstr Surg 1998, 102:1461-1478.
Chang DW, Youssef A, Cha S, Reece GP: Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 2002, 110:751-759; discussion 760-751.
Menke H, Erkens M, Olbrisch RR: Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg 2001, 47:107-114.
Barnett GR, Gianoutsos MP: The latissimus dorsi added fat flap for natural tissue breast reconstruction: report of 15 cases. Plast Reconstr Surg 1996, 97:63-70.
Roy MK, Shrotia S, Holcombe C, Webster DJ, Hughes LE, Mansel RE: Complications of latissimus dorsi myocutaneous flap breast reconstruction. Eur J Surg Oncol 1998, 24:162-165.
Papp C, McCraw JB: Autogenous latissimus breast reconstruction. Clin Plast Surg 1998, 25:261-266.
Munhoz AM, Montag E, Fels KW, Arruda EG, Sturtz GP, Aldrighi C, Gemperli R, Ferreira MC: Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg 2005, 116:741-752.
Kat CC, Darcy CM, O'Donoghue JM, Taylor AR, Regan PJ: The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery. Br J Plast Surg 1999, 52:99-103.
Titley OG, Spyrou GE, Fatah MF: Preventing seroma in the latissimus dorsi flap donor site. Br J Plast Surg 1997, 50:106-108.
Gendy RK, Able JA, Rainsbury RM: Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery. Br J Surg 2003, 90:433-439.
Navin C, Agrawal A, Kolar KM: The use of latissimus dorsi miniflap for reconstruction following breast-conserving surgery: experience of a small breast unit in a district hospital. World J Surg 2007, 31:46-50.
Rifaat MA, Amin AA, Bassiouny M, Nabawi A, Monib S: The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature. Indian J Plast Surg 2008, 41:24-33.
Randolph LC, Barone J, Angelats J, Dado DV, Vandevender DK, Shoup M: Prediction of postoperative seroma after latissimus dorsi breast reconstruction. Plast Reconstr Surg 2005, 116:1287-1290.