Abstract P2-19-04: Latissimus dorsi muscle onlay patch alternative to acellular dermal matrix is useful for implant-based breast reconstruction

Abstract

Abstract Introduction: The implants-based breast reconstruction is very useful method for breast conserving surgery in breast cancer. Recently, acellular dermal matrix (ADM) is applied to release the inferior pectoralis muscle for maintaining breast contour and to prevent burst out from the implant pocket. Authors applied latissimus dorsi (LD) muscle onlay patch instead of ADM for implant-based breast reconstruction. Patients and methods: From January to December 2012, a total of 20 patients with breast tumor underwent 22 cases of implant-based breast reconstruction with ADM or LD muscle onlay patch. The cosmetic outcome is assessed with 4-point scoring system at 4 weeks after from chemotherapy or radiotherapy. And the statistical analysis was evaluated between 2 groups. <Surgical technique> After conventional breast conserving surgery was done, the origin of the pectoralis major muscle are released and the window is checked pectoralis major muscle medially, rectus sheath inferiorly, and serratus anterior muscle laterally. Then, LD flap is sutured to cover this window with avoiding the vessel injury. The implant is inserted in the subpectoral pocket and breast reconstruction is finished with LD flap. Results: Mean operation time of ADM group and LD muscle onlay patch group was 153.9 and 299.7 minutes, respectively. (p = 0.054). Demographic characteristicsCharacteristicsADM (n = 10)LD muscle onlay patch (n = 12)p-valueAge (years)36.8±10.145.8±12.50.820BMI (kg/m2)19.0±2.023.4±3.430.065Volume loss (g)153.9±120.29299.7±116.030.030OP time (minutes)198±86.06342.5±54.70.054Hospital stay (days)6.9±1.528.7±1.560.059Follow-up period (Mo)6.2±2.668.7±1.560.232Interval period (days)19.9±6.2427.9±7.580.516Chenotherapy5110.056Radiotherapy590.378Complication 0.571Inflammation10 Seroma11 Cosmetic outcome 1.000Excellent34 Good55 Fair23 There were no significant differences between 2 groups; postoperative complication, cosmetic outcomes, and tumor characteristics. Tumor characteristicsCharacteristicsADM (n = 10)LD muscle onlay patch (n = 12)p-valueTumor type 0.088Atypical ductal hyperplasia20 Carcinoma in situ31 Invasive carcinoma511 Dermal invasion011.00Tumor size2.0±1.453.8±2.270.586Multicentricity310.293Stage 0.440031 I21 IIA24 IIB13 IIIA01 IIIB02 Microcalcification230.594Differentiation 0.038Well20 Moderate35 Poor06 Perineural invasion 0.706Positive01 Negative1011 Lymphovascular invasion 0.261Positive04 Negative108 Estrogen receptor 0.770Positive87 Negative05 Progesterone receptor 0.013Positive85 Negative07 c-erbB2 protein 0.074Positive04 Negative88 However, ADM was found to be much more expensive than LD muscle onlay patch.(p<0.001) Conclusion: Implant-based breast reconstruction with LD muscle onlay patch would be a feasible surgical technique alternative to ADM, when LD flap is planned for breast reconstruction. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-04.