Latissimus Dorsi Flap in Breast Reconstruction

Background: Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others. The LDF may be used in delayed or immediate reconstruction, in combination with tissue expanders for a staged reconstruction, with implant-based immediate reconstruction, or alone as an autogenous flap. Methods: The authors discuss the historical uses and more recent developments in the LDF. More recent advancements, including the “scarless” approach and augmentation with the thoracodorsal artery perforator flap, are discussed. Results: The LDF is a reliable means for soft tissue coverage providing form and function during breast reconstruction with acceptable perioperative and long-term morbidities. Conclusions: When there is a paucity of tissue, the LDF can provide tissue volume in autologous reconstruction, as well as a reliable vascular pedicle for implant-based reconstruction as in the setting of irradiated tissue.

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Modern breast reconstruction with endoscopically assisted latissimus dorsi flap harvesting

Orvosi Hetilap ◽

10.1556/oh.2014.29782 ◽

2014 ◽

Vol 155 (3) ◽

pp. 106-113 ◽

Cited By ~ 1

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.

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Post mastectomy breast reconstruction with autologous latissimus dorsi flap: a study of 30 cases

International Surgery Journal ◽

10.18203/2349-2902.isj20201548 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1412

Author(s):

Shipra Singla ◽

Vikas Kakkar ◽

Rana Ranjit Singh

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Rating Scale ◽

Radical Mastectomy ◽

Immediate Breast Reconstruction ◽

Latissimus Dorsi Flap ◽

Soft Tissue Coverage ◽

Flap Necrosis ◽

Form And Function

Background: There is a growing demand for breast reconstruction and among the plethora of breast reconstruction techniques, the latissimus dorsi (LD) flap is a versatile, reliable means for soft tissue coverage, providing form and function with acceptable perioperative and long-term morbidities for a variety of breast defects. The aim of this study was to find out the advantages of immediate breast reconstruction in terms of postoperative morbidity and patient satisfaction with respect to her expectations.Methods: The study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar. Thirty female patients who had undergone immediate breast reconstruction with latissimus dorsi flap after modified radical mastectomy attending surgery department from November 2017 to September 2019 were taken. The follow up was done to find out post-operative complications and a statistical scoring was done according to rating scale of quality of life.Results: Most common complication after breast reconstruction with LD flap was found to be seroma formation (50%) followed by wound infection and flap necrosis 25% each while flap necrosis >20% was not found in any case. For emotional feeling regarding health, social activities, overall health and quality of life; there was significant improvement after surgery.Conclusions: It can be concluded that immediate breast reconstruction with autologous latissimus dorsi flap is the treatment of choice following mastectomy in cases of breast carcinoma, whenever possible.

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Obesity and the Latissimus Dorsi Flap: A Radiologic Study

Plastic Surgery ◽

10.1177/22925503211031927 ◽

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.

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Effect of neoadjuvant chemotherapy on women undergoing breast cancer surgery and immediate breast reconstruction with latissimus dorsi flap and silicone implants

European Journal of Plastic Surgery ◽

10.1007/s00238-016-1263-x ◽

2016 ◽

Vol 40 (4) ◽

pp. 299-308

Author(s):

Gabriel Salum D’Alessandro ◽

Alejandro Povedano ◽

Lauren Klas Iurk Leme dos Santos ◽

Alexandre Mendonça Munhoz ◽

Rolf Gemperli ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Immediate Breast Reconstruction ◽

Cancer Surgery ◽

Latissimus Dorsi Flap ◽

Breast Cancer Surgery ◽

Silicone Implants

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Visual assessment of scapular position following delayed breast reconstruction with the latissimus dorsi flap or the thoracodorsal artery perforator flap

Annals of Breast Surgery ◽

10.21037/abs.2018.01.05 ◽

2018 ◽

Vol 2 ◽

pp. 5-5

Author(s):

Malte Rosen Rommedahl ◽

Mikkel Børsen Rindom ◽

Jørn Bo Thomsen ◽

Jens Ahm Sørensen

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Perforator Flap ◽

Visual Assessment ◽

Latissimus Dorsi Flap ◽

Thoracodorsal Artery ◽

Delayed Breast Reconstruction ◽

Thoracodorsal Artery Perforator Flap ◽

Artery Perforator

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Outcomes of skin sparing mastectomy with immediate breast reconstruction with Latissimus dorsi (LD) flap in surgical treatment of breast cancer

QJM ◽

10.1093/qjmed/hcaa050.060 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S M Othman ◽

A K Elfekky ◽

M E Elshinawi ◽

A G Othman

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Breast Conservation ◽

Immediate Breast Reconstruction ◽

Breast Conservation Surgery ◽

Autologous Reconstruction ◽

Immediate Reconstruction ◽

Aesthetic Result

Abstract Introduction Breast cancer is a devastating disease affecting women of all ages worldwide with the age incidence in Egypt being one decade younger than the mean age incidence, the latissimus dorsi (LD) flap is an important volume-replacement option due to its stability and versatility as an autologous flap. LD flap could be used for total breast reconstruction after mastectomy in selective cases or to fill a large quadrantectomy defect. Aim The aim of this study is to estimate the oncologic and aesthetic outcomes and the procedure-related complications of latissimus dorsi (LD) flap with skin sparing mastectomy in management of breast cancer. Patients On 25 patients breast cancer underwent skin-sparing mastectomy with immediate reconstruction using LD flap, Methods All patients were subjected to : (Complete history taken, General examination, Local examination and routine investigations) Surgical procedures 25 patients with breast cancer underwent skin-sparing mastectomy with immediate reconstruction with LD flap. Results Mean age of included patients was 41.12 years with mean BMI 29.17 kg/m2, regarding tumor classification DCIS represented 8% LCIS represented 20% IDC represented 32% ILC represented 40% of all patients, Positive lymph node 1-3 in 40% of patients and more than 3 in 20% of patients and 40% of patients had negative lymph node,96% of patients had no recurrence on the other hand only 4% shows locoregoinal recurrence, Regarding postoperative immediate complications 72% of patients showed no complications. Discussion In the current study we aimed to estimate the oncologic and aesthetic outcomes and the procedure-related complications of latissimus dorsi (LD) flap with skin sparing mastectomy in management of breast cancer. Conclusion Skin sparing mastectomy with immediate breast reconstruction using latissimus dorsi muscular flap allows single-stage, totally autologous reconstruction with a satisfactory aesthetic result, low morbidity, and good quality of life. Recommendations Breast cancer patients are best managed by a multidisciplinary team, Breast conservation surgery does often leave a significant deformity which can best be corrected by an immediate LD flap reconstruction, this method is simple and effective, our concept should be further analyzed in larger comparative studies.

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