Robotic-assisted Latissimus Dorsi Muscle Flap for Autologous Breast Reconstruction

Abstract

BACKGROUND: Latissimus dorsi (LD) muscle flap has been widely used for autologous breast reconstruction.1 Traditional open LD flap harvest requires a posterior donor site incision with a length of 15–45 cm. Although the scar can be camouflaged for women when wearing the bra, it tends to be long, frequently widens, and hypertrophies with time.2 Therefore, a minimally invasive technique to harvest LD muscle flap via endoscopic approach has been developed. Despite continuous improvements in surgical techniques and technologies, 2-dimensional view and nonflexible instruments are limitations of endoscopic harvest of the LD muscle flap.3 Meanwhile, a robotic-assisted LD muscle flap has been first introduced for autologous breast reconstruction after mastectomy.4 The authors has demonstrated a modified robotic surgical technique using a transaxillary gasless technique for robot-assisted LD muscle flaps in 2012.5 The purpose of this study was to introduce our 7-year experience with the robotic-assisted LD muscle flaps in autologous breast reconstruction. PATIENTS AND METHODS: Between October 2012 and February 2019, a total of 33 patients underwent autologous breast reconstructions using robotic-assisted LD muscle flap. Among 33 patients, 21 patients had Poland syndrome. Seven and 3 patients underwent robotic-assisted LD flap following immediate and delayed breast reconstruction after mastectomy, respectively. Two patients had capsular contracture of implant. Subjective assessment was performed to evaluate satisfaction of overall outcome, breast symmetry, and scar. Mean follow-up time was 29.8 ± 12.5 months (range, 3–61 months). RESULTS: All 33 flaps were successfully transferred without converting to open technique. As our experience with robotic-assisted LD flap increased steadily over the years, we have achieved improvements in surgical techniques and robotic instruments to comfort during surgery, optimize the results, and minimize complications and contour defects compared to the first time with robotic surgery. In addition, the time for robotic surgery system also markedly decreased after experience accumulation. Recently, the time for robotic docking and robotic surgery was about 30 and 60 minutes, respectively. At the last visit, patients’ average grading of satisfaction of overall outcome, breast symmetry, and scar were 4.75 ± 0.23, 4.32 ± 0.63, and 4.88 ± 0.15, respectively. No serious complications such as flap loss were recorded for any patient. CONCLUSION: Autologous breast reconstruction using robotic-assisted LD muscle flap might be effective and safe. REFERENCES: 1. Arslan E, Unal S, Demirkan F, et al. Poland’s syndrome with rare deformities: reconstruction with latissimus dorsi muscle through a single short incision. Scand J Plast Reconstr Surg Hand Surg. 2003;37:304–306. 2. Moore TS, Farrell LD. Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg. 1992;89:666–672; discussion 673–664. 3. Pomel C, Missana MC, Atallah D, et al. Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol. 2003;29:127–131. 4. Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg. 2012;129:1305–1312. 5. Chung JH, You HJ, Kim HS, et al. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg. 2015;68:966–972.