Latissimus dorsi flap in breast reconstruction following radical mastectomy and prophylactic subcutaneous mastectomy in the same patient: Case report

Abstract

One of the most common surgical treatment options for breast cancer is radical mastectomy, which affects the quality of life of patients in remission and their psychological state. One of the solutions to this problem is the use of skin and muscle flaps from other anatomical areas, in particular the back, for plastic reconstruction of the breast after radical mastectomy. The study aimed to present the practical implementation of reconstruction of both breasts in the remote period of radical mastectomy in a patient in remission of breast cancer using a skin and muscle flap of the broadest back muscle in combination with an implant. The patient, who met the criteria for participation in the study, had previously undergone a radical mastectomy of the right breast for direct indications along with radiotherapy. Delayed breast reconstruction within the study was performed 6 years after the planned right-sided mastectomy. The first surgical intervention included marking the back and breast area, excision and harvesting of the flap, preparation of the implantation site and its placement with the implant. Three months after the operation, she underwent a prophylactic mastectomy of the left breast based on molecular genetic testing with immediate reconstruction using the second flap of the broadest back muscle. The surgery was performed using a perimammary approach. Due to the available dissection, various anatomical configurations of the flap, and low-variability vascular anatomy, the latissimus dorsi flap is an adequate choice of material for the reconstruction of radical postmastectomy interventions. The final result of bilateral use of the flap for breast reconstruction after mastectomy is in favour of restoration of the anatomical tissue defect and a satisfactory aesthetic option, without complications in the form of seromas, haematomas, or pain. The result has a positive impact on the quality of life of a patient in remission of breast cancer