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

Received: 27 July 2015    Accepted: 6 August 2015    Published: 19 August 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

Published in Journal of Surgery (Volume 3, Issue 5)
DOI 10.11648/j.js.20150305.11
Page(s) 44-49
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Breast Cancer, Latissimus Dorsi Flap, Breast Reconstruction, Complications

References
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[2] 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.
[3] Hamdi M, Wolfli J, Van Landuyt K: Partial mastectomy reconstruction. Clin Plast Surg 2007, 34:51-62; abstract vi.
[4] 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.
[5] Knight MA, Nguyen DTt, Kobayashi MR, Evans GR: Institutional review of free TRAM flap breast reconstruction. Ann Plast Surg 2006, 56:593-598.
[6] 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.
[7] 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.
[8] Raja MA, Straker VF, Rainsbury RM: Extending the role of breast-conserving surgery by immediate volume replacement. Br J Surg 1997, 84:101-105.
[9] 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.
[10] 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.
[11] 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.
[12] 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.
[13] 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.
[14] 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.
[15] Papp C, McCraw JB: Autogenous latissimus breast reconstruction. Clin Plast Surg 1998, 25:261-266.
[16] 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.
[17] 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.
[18] Titley OG, Spyrou GE, Fatah MF: Preventing seroma in the latissimus dorsi flap donor site. Br J Plast Surg 1997, 50:106-108.
[19] 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.
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[21] 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.
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    Hussein Fakhry, Kassim Abdelazeem, Hesham Hamza, Badawy Ahmed, Mahmod Mostafa, et al. (2015). Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications. Journal of Surgery, 3(5), 44-49. https://doi.org/10.11648/j.js.20150305.11

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    ACS Style

    Hussein Fakhry; Kassim Abdelazeem; Hesham Hamza; Badawy Ahmed; Mahmod Mostafa, et al. Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications. J. Surg. 2015, 3(5), 44-49. doi: 10.11648/j.js.20150305.11

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    AMA Style

    Hussein Fakhry, Kassim Abdelazeem, Hesham Hamza, Badawy Ahmed, Mahmod Mostafa, et al. Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications. J Surg. 2015;3(5):44-49. doi: 10.11648/j.js.20150305.11

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  • @article{10.11648/j.js.20150305.11,
      author = {Hussein Fakhry and Kassim Abdelazeem and Hesham Hamza and Badawy Ahmed and Mahmod Mostafa and Gamal Amira and Arwa M. Ali},
      title = {Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications},
      journal = {Journal of Surgery},
      volume = {3},
      number = {5},
      pages = {44-49},
      doi = {10.11648/j.js.20150305.11},
      url = {https://doi.org/10.11648/j.js.20150305.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20150305.11},
      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},
     year = {2015}
    }
    

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  • TY  - JOUR
    T1  - Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications
    AU  - Hussein Fakhry
    AU  - Kassim Abdelazeem
    AU  - Hesham Hamza
    AU  - Badawy Ahmed
    AU  - Mahmod Mostafa
    AU  - Gamal Amira
    AU  - Arwa M. Ali
    Y1  - 2015/08/19
    PY  - 2015
    N1  - https://doi.org/10.11648/j.js.20150305.11
    DO  - 10.11648/j.js.20150305.11
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 44
    EP  - 49
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20150305.11
    AB  - 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
    VL  - 3
    IS  - 5
    ER  - 

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Author Information
  • Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

  • Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

  • Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

  • Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

  • Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

  • Surgical Oncology Department, National Cancer Institute, Cairo University, Assiut, Egypt

  • Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

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