Short-Scar Latissimus Dorsi (SSLD) With a Lateral Approach: A Game Changer in Breast Reconstruction?

2021 ◽  
Author(s):  
Simon Perez ◽  
Emmanuel Delay ◽  
Raphaël Sinna ◽  
Traian Savu ◽  
Richard Vaucher ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Skin Necrosis ◽  
Lateral Approach ◽  
Advancement Flap ◽  
Autologous Reconstruction ◽  
Skin Paddle ◽  
Cutaneous Tissue ◽  
Delayed Breast Reconstruction ◽  
Short Scar

Abstract Background In delayed breast reconstruction, the thoraco-mammary cutaneous tissue often shows residual damage from radiotherapy. The fragility of this tissue is associated with a risk of skin necroses of about 8% when dissection is performed by reopening of the mastectomy scar. Objectives The objective of our study was to adapt the technique of short-scar latissimus dorsi flap surgery with an abdominal advancement flap using a lateral approach only avoiding re-incision of the mastectomy scar. Methods In this retrospective study, we performed 150 reconstructions in 146 patients to assess the safety and effectiveness of the SSLD technique with lateral approach. The primary outcome was the occurrence of postoperative skin necrosis of the thoraco-mammary area. Results Of the 150 delayed breast reconstruction procedures performed, none showed skin necrosis of the thoraco-mammary area, and a positive effect on skin trophicity of this area was observed. The resulting patient and surgical team satisfaction were very favorable. Conclusions In our practice, this technique changed our paradigm because of good skin safety and effectiveness. It allows reconstruction without a patch-effect in patients with very poor skin quality in whom the thoraco-mammary skin would have been replaced in the past by a skin paddle. Reconstruction would have even be contraindicated. It could also be an alternative to many other more complex and longer techniques of autologous reconstruction.

Obesity and the Latissimus Dorsi Flap: A Radiologic Study

2021 ◽  
pp. 229255032110319
Author(s):  
Joshua H. Choo ◽  
Bradley J. Vivace ◽  
Luke T. Meredith ◽  
Swapnil Kachare ◽  
Thomas J. Lee ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Normal Weight ◽  
Latissimus Dorsi Flap ◽  
Class I ◽  
Autologous Reconstruction ◽  
Complication Rates ◽  
Obese Patients ◽  
Weight Category ◽  
Flap Thickness

Introduction: The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Methods: Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography–guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. Results: A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted R 2 of 0.682, P < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted R 2 of 0.553, P < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. Conclusion: The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.

Vertical Skin Paddle Orientation for the Latissimus Dorsi Flap in Breast Reconstruction

2018 ◽  
Vol 141 (3) ◽  
pp. 598-601 ◽  
Author(s):  
Megan Fracol ◽  
Michelle Grim ◽  
Steven T. Lanier ◽  
Neil A. Fine
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Latissimus Dorsi Flap ◽  
Skin Paddle

Check the Record: Remote CT Scans for Breast Flap Perforator Mapping

2018 ◽  
Vol 34 (07) ◽  
pp. 485-491 ◽  
Author(s):  
Amanda Sergesketter ◽  
Bryan Pyfer ◽  
Brett Phillips ◽  
Ruya Zhao ◽  
Scott Hollenbeck
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Ct Scans ◽  
Autologous Reconstruction ◽  
Positron Emission ◽  
Pet Ct ◽  
Delayed Breast Reconstruction ◽  
Average Utility

Background Perforator mapping with computed tomography angiography (CTA) prior to autologous breast reconstruction reduces donor-site morbidity and operative time, but is costly. The aim of this study was to evaluate whether pre-existing CT scans could be used for dominant perforator identification before autologous reconstruction. Methods We identified all female patients who underwent mastectomy with immediate or delayed breast reconstruction with abdominal free flaps at a single institution between 2006 and 2016. Medical records were reviewed to identify patients with pre-existing CT scans of the abdomen/pelvis. CT images were reviewed by the senior surgeon and ranked on a 1 to 3 scale to indicate utility for preoperative planning. An analysis was performed to assess financial savings and radiation avoidance associated with the use of pre-existing scans. Results Of 301 identified patients, 44.9% (n = 135) had an available pre-existing CT. A dominant perforator was identified on 92.6% of scans. A higher proportion of dominant perforators was identified using positron emission tomography (PET)/CT scans compared with CT scans with intravenous (IV) contrast and noncontrast CTs (p < 0.0001). Compared with PET/CTs and CTs with IV contrast, the average utility score for noncontrast CTs was lower (p = 0.0001). Dominant perforators were clearly identified in patients who had both a remote CT scan and a preoperative CTA. Perforator mapping using remote CT scans yielded a projected radiation reduction of 13.2 mGy per patient and yielded a projected annual U.S. health care savings of $28,459,638. Conclusion Our study suggests that pre-existing CT scans represent a viable and economical alternative for perforator mapping before abdominal-based free flap breast reconstruction.

Modern breast reconstruction with endoscopically assisted latissimus dorsi flap harvesting

2014 ◽  
Vol 155 (3) ◽  
pp. 106-113 ◽  
Author(s):  
Zoltán Mátrai ◽  
Csaba Kunos ◽  
Dávid Pukancsik ◽  
Ákos Sávolt ◽  
Gusztáv Gulyás ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Complex Interventions ◽  
Muscle Flap ◽  
Latissimus Dorsi Flap ◽  
Breast Cancer Surgery ◽  
Soft Tissue Coverage ◽  
Autologous Reconstruction ◽  
Skin Envelope ◽  
Axillary Lymphadenectomy

Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian. Orv. Hetil., 2014, 155(3), 106–113.

The Significance of Latissimus Dorsi Flap Innervation in Delayed Breast Reconstruction

2011 ◽  
Vol 128 (6) ◽  
pp. 637e-645e ◽  
Author(s):  
Minna Kääriäinen ◽  
Salvatore Giordano ◽  
Susanna Kauhanen ◽  
Anna-Leena Lääperi ◽  
Pentti Mattila ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Latissimus Dorsi Flap ◽  
Delayed Breast Reconstruction
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