Immediate Breast Reconstruction Following Segmentectomy Using A Rolled Latisimuss Dorsi Flap

Abstract

Immediate primary breast reconstruction is practiced in many centers. It is a safe, simple and rapid method, which is costeffective and can be done with using pedicled flaps from the latissimus dorsi or rectus abdominus muscle [1]. Further enhancement of the breast contour may be achieved with expander devices and silicone implants [2]. We describe a technique of immediate breast reconstruction following segmentectomy and axillary clearance using a rolled latissimus dorsi pedicle flap. The latissimus dorsi mobilisation is done using the same cosmetic axillary incision used for nodal clearance without the need for extending it or creating an additional incision. It is suited for the lateral aspect of the breast following segmentectomy and does not limit postoperative radiotherapy, since this flap is well vascularised. A very wide clearance is also possible without fear of deforming the breast, since reconstruction will fill the defect well with a good cosmetic result. CASE REPORTS CASE 1: A 45-year old female presented with a history of a hard lump in the left upper outer quadrant of the left breast of 3 months duration and approximately 2cm in size. The past gynaecologic history and family history was not significant. Triple assessment showed this to be an invasive ductal carcinoma. A segmentectomy was performed through a incison placed over the lump in the upper outer quadrant along Langer's lines. Following this an a level II axillary clearance was done using a separate axillary incision. A latissimus dorsi pedicled flap was then raised through this axillary incision and the edge rolled to give the correct contour and ptosis to the breast to achieve symmetry with the contralateral side. A suction drain was left in the axilla to prevent seroma formation. This was removed at 2 weeks follow-up and at 6 weeks postoperatively the contour and ptosis was excellent. Patient satisfaction was high and tumour free margins were achieved. CASE 2: A 36-year old female presented with a history of a hard lump in the right upper outer quadrant of the right breast of 1 month duration and approximately 4cm in size. There was a family history of breast cancer. Triple assessment showed this to be an invasive ductal carcinoma. A segmentectomy was performed through an incison placed over the lump in the upper outer quadrant along Langer's lines. Following this a level II axillary clearance was done using a separate axillary incision. A latissimus dorsi pedicled flap was then raised through this axillary incision and the edge ‘rolled' to give the correct contour and ptosis to the breast to achieve symmetry with the contralateral side. A suction drain was left in the axilla to prevent seroma formation. This was removed at 2 weeks follow-up and at 6 weeks postoperatively the contour and ptosis was excellent. Patient satisfaction was also high and tumour free margins were achieved. TECHNIQUE We now describe yet another technique, which we have performed in two cases; whereby immediate breast reconstruction has been achieved using a “rolled, latissimus dorsi pedicled flap with no prosthesis”. The operation is carried out with the patient supine (the back is not lifted). The arm is draped separately for movement. An incision is made over the tumour through Langer's lines in the breast and a segmentectomy done [Fig 1] with clearance of tumour right down to the pectoralis major [Fig 2,3]. Immediate Breast Reconstruction Following Segmentectomy Using A Rolled Latisimuss Dorsi Flap