Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients

Abstract Background Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery. Methods A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction. Results The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases. Conclusions The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

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Latissimus Dorsi Muscle Flap Transfer Through Endoscopic Approach Combined With the Implant After Tissue Expansion for Breast Reconstruction of Mastectomy Patients

10.21203/rs.3.rs-888321/v1 ◽

2021 ◽

Author(s):

Jian-Xun Ma ◽

Bi Li ◽

You-Chen Xia ◽

Wei-Tao You ◽

Jie Zhang ◽

...

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Muscle Flap ◽

Tissue Expansion ◽

Latissimus Dorsi Muscle ◽

Harvest Time ◽

Latissimus Dorsi Muscle Flap ◽

Dorsi Muscle ◽

Drain Time ◽

The Mean

Abstract Background: The increasing demand for breast reconstruction and good outcomes lead plastic surgeons to look for a new method to obtain more natural and aesthetically pleasing appearance of the reconstructed breasts.Methods: A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the symmetry of bilateral breasts.Results: The mean endoscopic LDMF harvest time was 90.4 minutes (70.0~120.0 min). The average drain time after the final reconstruction was 10.1 days (6~19 days). In the mean follow-up of 11.2 months (6~28 months), there were no postoperative complications noted. The average post–reconstruction breasts asymmetry was 4.8%±2.4%, the reconstructed side achieved good volume symmetry to the contralateral side (P=0.256).Conclusions: The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, shorten the LDMF harvest time and reduce the incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

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Latissimus Dorsi Muscle Flap and Tissue Expansion for Breast Reconstruction

Annals of Plastic Surgery ◽

10.1097/01.sap.0000230203.86430.a3 ◽

2006 ◽

Vol 57 (6) ◽

pp. 597-601 ◽

Cited By ~ 15

Author(s):

Maurice Mimoun ◽

Marc Chaouat ◽

Bruno Lalanne ◽

St??phane Smarrito

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Muscle Flap ◽

Tissue Expansion ◽

Latissimus Dorsi Muscle ◽

Latissimus Dorsi Muscle Flap ◽

Dorsi Muscle

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A case of breast reconstruction using waistline incisional extended latissimus dorsi muscle flap

International Cancer Conference Journal ◽

10.1007/s13691-013-0097-7 ◽

2013 ◽

Vol 2 (4) ◽

pp. 234-237

Author(s):

Atsumori Hamahata ◽

Kazuyuki Kubo ◽

Takashi Saitou ◽

Takashi Yamaki ◽

Hiroyuki Takei ◽

...

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Muscle Flap ◽

Latissimus Dorsi Muscle ◽

Latissimus Dorsi Muscle Flap ◽

Dorsi Muscle

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Robotic Surgery in Breast Reconstruction: Harvest of the Latissimus Dorsi Muscle Flap

Breast Reconstruction ◽

10.1007/978-3-319-18726-6_73 ◽

2016 ◽

pp. 765-773

Author(s):

Amir E. Ibrahim ◽

Mark Clemens ◽

Karim A. Sarhane ◽

Jesse C. Selber

Keyword(s):

Robotic Surgery ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Muscle Flap ◽

Latissimus Dorsi Muscle ◽

Latissimus Dorsi Muscle Flap ◽

Dorsi Muscle

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Avaliação da morbidade da área doadora do retalho de Grande Dorsal

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v9i2.4950 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Thiago Pereira de Santana ◽

Felipe de Souza Serenza ◽

Fernanda Ruiz de Andrade ◽

Luis Guilherme Rosifini Alves Rezende ◽

Amanda Favaro Cagnolati ◽

...

Keyword(s):

Systematic Review ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Donor Site ◽

Muscle Flap ◽

Latissimus Dorsi Muscle ◽

Seroma Formation ◽

Latissimus Dorsi Flap ◽

Latissimus Dorsi Muscle Flap ◽

Dorsi Muscle

Introdução: As falhas de cobertura nas extremidades são um grande desafio terapêutico. Dentre as várias opções disponíveis para manejo da cobertura encontra-se o retalho livre do Músculo Grande Dorsal, devido sua grande versatilidade e características anatômicas do pedículo. Objetivo: avaliação da morbidade da área doadora do retalho livre de grande dorsal. Métodos: 7 pacientes avaliados em relação a morbidade da área doadora, seja pelo componente estético, álgico e funcional (amplitude de movimento residual). Resultados: 71,4% dos pacientes repetiriam o mesmo procedimento cirúrgico se necessário. 85,7% indicariam o mesmo procedimento para outros pacientes. Discussão: Devido baixa morbidade da área doadora, o retalho livre de grande dorsal encontra-se uma excelente opção na literatura. Nossos dados corroboram com os resultados apresentados em outros estudos, porém com algumas variações na amplitude de movimento mensurada nos pacientes. Conclusões: Devido grande versatilidade e baixa morbidade na área doadora, o retalho livre de Grande Dorsal é uma excelente opção para falhas de cobertura.Descritores: Retalhos Cirúrgicos; Microcirurgia; Procedimentos Cirúrgicos Reconstrutivos.ReferênciasPederson WC. Nonmicrosurgical coverage of the upper extremity. In: Green´s Operative Hand Surgery. Wolfe SW, Hotchkiss RN, Pederson WC et al. (Org.). 7. Ed. Philadelphia: Elsevier, 2017. cap. 44, p. 1528-1573. v. 2.Jobe MT. Microcirurgia. In: Cirurgia Ortopédica de Campbell. Canale ST (Org.). 10. ed. [S.l.]: São Paulo: Manole, 2006. cap. 60, p. 3287-3371. v. 4.Spear SL, Hess CL. A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles. Plast Reconstr Surg. 2005;115(7):2070-73.Paolini G, Amoroso M, Pugliese P, Longo B, Santanelli F. Functional sequelae following bilateral mastectomy and immediate reconstruction with latissimus dorsi flap: medium-term follow-up. J Plast Surg Hand Surg. 2014;48(2):99-103.Benditte-Klepetko HC, Lutgendorff F, Kästenbauer T, Deutinger M, van der Horst CM. Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction. Scand J Surg. 2014;103(4):249-55.Nagarkar P, Lakhiani C, Cheng A, Lee M, Teotia S, Saint-Cyr M. No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures. Plast Reconstr Surg Glob Open. 2016;4(4):e672.Mannu GS, Qurihi K, Carey F, Ahmad MA, Hussien M. Quilting after mastectomy significantly reduces seroma formation. S Afr j surg. 2015;53(2):50-4.Sajid MS, Betal D, Akhter N, Rapisarda IF, Bonomi R. Prevention of postoperative seroma-related morbidity by quilting of latissimus dorsi flap donor site: a systematic review. Clin Breast Cancer. 2011;11(6):357-63.Lee KT, Mun GH. Fibrin Sealants and Quilting Suture for Prevention of Seroma Formation Following Latissimus Dorsi Muscle Harvest: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2015;39(3):399-409.Llewellyn-Bennett R, Greenwood R, Benson JR, English R, Turner J, Rayter Z et al. Randomized clinical trial on the effect of fibrin sealant on latissimus dorsi donor-site seroma formation after breast reconstruction. Br J Surg. 2012; 99(10):1381-1388.Cheng HT, Hsu YC, Wu CI. Quilting sutures, fibrin tissue adhesive or both in reducing the incidence of seroma in the latissimus dorsi flap donor site? An evidence-based analysis. J Plast Reconstr Aesthet Surg. 2014;67(6):881-82.Lee J, Bae Y, Jung JH, Kim WW, Hwang SO, Kwon TJ et al. Effects of Quilting Suture Interval on Donor Site Seromas After Breast Reconstruction With Latissimus Dorsi Muscle Flap: A Randomized Trial. Clin Breast Cancer. 2016;16(6):e159-64.Watanabe K, Morihisa Y, Gotanda K, Kiyokawa K. A case of a chronic expanding hematoma that developed in a latissimus dorsi muscle flap donor site. J Plast Reconstr Aesthet Surg. 2013;66(6):872-74.Pyon JK, Kang BY, Mun GH, Bang SI, Oh KS, Lim SY. Extra-Abdominal Desmoid Tumor in the Donor Site of an Extended Latissimus Dorsi Flap. Arch Plast Surg. 2016;43(1):114-16.Cools AM, De Wilde L, Van Tongel A, CeyssensC, Ryckewaert R, Cambier DC. Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. J Shoulder Elbow Surg. 2014;23(10):1454-61. Katoh M. Test-retest reliability of isometric shoulder muscle strength measurement with a handheld dynamometer and belt. J Phys Ther Sci. 2015;27(6):1719-22.Celik D, Dirican A, Baltaci G. Intrarater reliability of assessing strength of the shoulder and scapular muscles. J Sport Rehabil. 2012;21(1):1-5.Button J, Scott J, Taghizadeh R, Weiler-Mithoff E, Hart AM. Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. J Plast Reconstr Aesthet Surg. 2010;63(9):1505-12.Lee KT, Mun GH. A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg. 2014;134(2):303-14.Garusi C, Manconi A, Lanni G, et al. Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study - Combining DASH score and objective evaluation. Breast. 2016;27:78-86.

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