The Muscle-Sparing Latissimus Dorsi Flap for Breast Reconstruction

Abstract

Sir: We read the article by Saint-Cyr et al. with interest and would like to congratulate the authors on a typically comprehensive and beautifully illustrated article.1 Although partial latissimus dorsi flaps have been used as free tissue transfer for small defects, for example, in lower limb trauma, the article represents an elegant example of lateral thinking for breast reconstruction. The reduction in seroma rate, one of the principal drawbacks of latissimus dorsi harvest, appears particularly impressive. Our institute has a particular interest in the reparative surgery for aesthetic deformity following breast-conserving therapy, so the described technique, by leaving the main thoracodorsal pedicle in situ, theoretically “burns no bridges” for future latissimus dorsi reconstruction if required. With this in mind, we would be interested in finding out whether the authors have any experience with harvest of the remaining, transverse pedicle–supplied latissimus dorsi? Also, with respect to the narrow muscle pedicle, we note the predominant use of the muscle-sparing latissimus dorsi in skin-sparing mastectomy and wonder about the skin paddle extremity vascularity and any limits on dimensions that this may impose if more donor skin is required. Finally, it is well-recognized that the use of adjuvant radiotherapy, planned or otherwise, can both severely compromise the aesthetic result2,3 and substantially increase the incidence of adverse capsular contracture,4,5 even when mammary prostheses are covered completely by muscle. With such implants being only partially covered—with pectoralis major superomedially—would the muscle-sparing latissimus dorsi risk elevated rates of adverse capsular contracture and implant exposure? M. G. Berry, F.R.C.S.(Plast.) A. Curnier, F.R.C.S.(Plast.) A. D. Fitoussi, M.D. B. Couturaud, M.D. R. J. Salmon, M.D., Ph.D.