Morbidité et qualité de vie après reconstruction mammaire par lambeau de grand dorsal autologue, à épargne musculaire et perforant

Abstract

Morbidity following autologous latissimus dorsi flap (ALD), muscle sparing latissimus dorsi flap (MSLD) and thoracodorsal artery perforator flap (TAP) is controversial. The purpose of this study was to measure morbity using Quick Dash at 1month and 1year following breast reconstruction with one of these three flaps. The second objective was the evaluation of quality of life using Breast-Q. Thirty four consecutive patients who had undergone breast reconstruction were included in this monocentric and prospective study: 10patients in the ALD group, 12patients in the MSLD group and 12patients in the TAP group. At 1month and 1year following surgery, the variation of Quick Dash was 13,63and 2,38in the ALD group, 3,41and -1,13in the MSLD group and 5,69and 0in the TAP group. Satisfaction whith breasts, psychosocial, sexual and chest well-being were higher in the ALD group. Satisfaction with back was higher in the MSLD and TAP groups. Back and shoulder well-being was comparable regardless of the flap. Seroma occurrence was very rare in case of TAP, rare and not abundant in case of MSLD and frequent in case of ALD. This study appears to confirm that immediate morbidity is less important with MSLD or TAP than ALD. Hoewever at one year following surgery, morbity seems to be comparable with the 3flaps. Patients satisfaction seems to be higher with ALD except for the aspect of the back.