Anatomical Emphasis for the Latissimus Dorsi Myocutaneous Flap for Breast Reconstructive Surgery Patient Education

Abstract

Introduction & Objective Reconstructive surgeries among breast cancer survivors continue to increase due to public recognition of the disease and ever-increasing diagnoses. Multiple reconstructive techniques are presented to patients, each with indications relating to disease severity and patient presentation. The latissimus dorsi myocutaneous (LD) flap is one of several viable options for breast reconstruction with minimal post-operative complications and provides a natural-looking breast and sensation recovery. However, patient education materials with detailed anatomical illustrations are lacking. The objective of this study is to provide original patient education materials with detailed anatomical illustrations for breast reconstructive surgery, specifically the latissimus dorsi myocutaneous flap. Materials and Methods An extensive review of literature was conducted using a critical interpretive synthesis to obtain a detailed anatomical description of the LD flap as well as its indications for patient populations and post-operative complications. Results Articles containing relevant surgical descriptions of the LD flap procedure and the appropriate anatomy were used for incorporation in this review. Qualitative data analysis of literature revealed indications and anatomical details for original creation of illustrations for patient education. The LD flap is a useful graft for women with low BMI who wish to have a scar easily covered by undergarments. The LD flap is a skin, muscle, and fat flap supplied by the thoracodorsal artery and the thoracodorsal nerve. Variability exists but does not pose an issue to relocation of the flap through the tunnel created subcutaneously. The skin island is reattached in the area of the defect and can be cutaneously reinnervated via neurorrhaphy between the prominent intercostal nerves of the breast region. Women can have satisfactory results of the LD flap reconstruction, immediately or delayed. Reconstruction with a LD flap is widely tolerated with significant satisfaction and minimal post-operative complications. The LD flap had decreased satisfaction in those who selected an immediate reconstruction, potentially due to the expectation for the breast to look identical to the original. The recovery of sensation varies, but may never return fully. Conclusion With increasing demands for surgeons to make a perfect breast, numerous techniques presented to the patient can be overwhelming. It is important to supply adequate information concerning the LD flap operation for the patient to be informed and to have realistic expectations of the reconstruction outcome. Education with images and patient appropriate descriptions may help patients to have a better understanding of the surgery they are undergoing and the results to be expected. Significance As breast cancer maintains its place as one of the most common cancers among women in the United States, second only to certain forms of skin cancer, focus on the quality of life of survivors potentially can benefit millions. Future work aims to measure the effectiveness of anatomical illustrations in patient education materials pre- and post-surgery.