Comparison of the Pedicled Latissimus Dorsi Flap With Immediate Fat Transfer Versus Abdominal-based Free Flaps for Breast Reconstruction

Abstract

PURPOSE: Abdominally based free flaps and the latissimus dorsi and immediate fat transfer (LIFT) procedure are both fully autologous options for breast reconstruction. The former is specialized and requires comfort with microsurgical technique while the LIFT combines a common set of techniques familiar with all plastic surgeons. Comparison of the 2 methods for clinical effectiveness and complications for equivalency in outcomes may help elucidate and enhance patient decision-making. METHODS: A retrospective review was performed to analyze outcomes of both patients who underwent the LIFT procedure and patients who underwent abdominal-based flaps between March 2017 and July 2018 by the senior surgeon. Data were analyzed per breast. Outcomes of interest included postoperative complications, flap success, and follow-up revision and fat grafting procedures. Continuous variables between the 2 groups were compared using the 2-sample t test. Categorical variables were compared using Pearson’s chi-square and Fischer’s exact tests as appropriate. RESULTS: Sixty-five breasts were identified as having undergone abdominal-based flap procedures, and 31 breasts underwent the LIFT procedure. Average follow-up time was 8 months (± 4.6 months) for the abdominal-based flap patients and 7.9 months (± 4.2 months) for the LIFT patients (P > 0.05). Demographics were not statistically different between the 2 flap cohorts (P > 0.05). This includes age, body mass index (abdominal-based flaps, 29.9 ± 4.76; LIFT, 28.2 ± 6.2 kg/m2), diabetes mellitus, hypertension, connective tissue disease, and current tobacco use. Additionally, the use of neoadjuvant chemotherapy and adjuvant radiation was not statistically different between the 2 groups (P > 0.05). The LIFT procedure cohort had a shorter length of operation time (375 ± 136 minutes) as compared to the abdominal-based flap cohort (514 ± 136 minutes) (P < 0.001). Similarly, the LIFT cohort had a shorter length of hospital stay (1.65 ± 0.85) than the abdominal-based flap cohort (3.83 ± 1.65) (P < 0.001). However, the average abdominal-based flap procedure had a shorter time until drain removal (13.3 ± 4.3 days) as compared to the LIFT (24.0 ± 11.2 days). The number of overall, major (requiring operation), and minor complications including infection/cellulitis, seroma, dehiscence, hematoma, and flap issues and/or failure were also not statistically different (abdominal-based flaps: major 20.0%, minor 27.7%; LIFT: major 12.9%, minor 19.35%). Similarly, the need for reoperations for revisions (abdominal-based flaps 0.80 ± 0.71 versus LIFT 0.87 ± 0.71) and fat grafting (abdominal-based flaps 41.54% versus LIFT 58.8%) was not statistically different. CONCLUSIONS: Both the LIFT versus abdominally based free flaps have similar outcomes and complication rates. However, the LIFT may be preferred in patients that require shorter operation times due to comorbid medical conditions or with severe obesity which may result in abdominal donor site problems. Furthermore, the LIFT may be the fully autologous breast reconstruction choice for nonmicrosurgeons.