Extended Latissimus Dorsi Flap Research Articles

Breast Reconstruction Using the Extended Latissimus Dorsi Myocutaneous Flap-A Long-term Follow-up Utilizing BREAST-Q.

The latissimus dorsi (LD) flap is a commonly used method for breast reconstruction after mastectomy. In this study, we present a long-term follow-up and effects of refining surgery on patient satisfaction and quality of life after breast reconstruction with the extended LD flap, using the BREAST-Q questionnaire. The aim of this study was to investigate the patient-reported long-term results after breast reconstruction with the extended LD myocutaneous flap. A retrospective cohort study of adult patients (n = 101) who were operated on using the extended LD flap for breast reconstruction at the Linköping University Hospital during 1997 to 2012 was made using data retrieved from medical records. The patients were asked to complete the BREAST-Q questionnaire at 2 different postoperative time points. Eighty-three patients replied to the first questionnaire, and 56 patients also replied to the second. Mean follow-up was 11.7 years. Higher age and living together with someone correlated to higher BREAST-Q results, while postoperative infection, bilateral LD flaps, smoking, and prior breast surgery had a negative impact on the results. Overall BREAST-Q results increased over time. No independent effect of refining surgery could be shown. Patient satisfaction after breast reconstruction with the LD flap as measured with the BREAST-Q questionnaire is high and in line with other studies. The overall satisfaction with the reconstruction method seems to increase with time, but no further increase in satisfaction after refining surgery could be established.

Usefulness of Harmonic ACE+7 Scalpel in Breast Reconstruction with Extended Latissimus Dorsi Flap: An Open-label Single Institution Pilot Study.

We compared 27 patients who underwent breast reconstruction with the ELD flap using the Harmonic ACE +7 scalpel, and 28 patients who underwent breast reconstruction using an electrocautery scalpel, between May 2019 and March 2022. Data on patient demographics, surgery, and postoperative complications were collected. Surgical outcomes were compared between electrocautery (EC) and Harmonic ACE+7 (HA) groups. The median age of the patients was 50.2 years. The patient demographics between the groups did not show significant differences. Flap necrosis and hematomas did not occur, and seroma was the major postoperative complication (65.7% in the EC group and 70% in the HA group). The time required for flap elevation was significantly shorter in the HA group than in the EC group (286.0 minutes and 179.0 minutes, respectively). Blood loss reduced significantly in the HA and EC groups (138.5 mL and 78.2 mL, respectively). Moreover, decreased drainage was observed for the breast area. There were no significant differences in other end points. In breast reconstruction with ELD flaps, using the Harmonic ACE+7 can help reduce the rate of seroma, operative time, and intraoperative bleeding without further disadvantages.

Scarless Donor Site for Breast Reconstruction by Endoscopically Assisted Extended Latissimus Dorsi Flap plus Lipofilling.

Breast reconstruction using endoscopically assisted latissimus dorsi (LD) flap leaves no scar on the back; however, the small amount of tissue obtained makes this procedure less practical. This study aimed to propose a new technique of endoscopically assisted extended LD (eeLD) flap plus lipofilling, which could secure a large breast volume. Lateral thoracic adipose tissues supplied by the thoracodorsal artery branches and the LD muscle were elevated as a single unit only through the mastectomy scar and three ports through the lateral chest. Furthermore, fat was simultaneously injected to support the volume and shape of the breast. Changes in the volume of the reconstructed breast over time were measured using three-dimensional stereophotogrammetry. Overall, 15 breasts of 14 patients who underwent breast reconstruction using an eeLD flap exhibited no serious complications. On average, 281.9 ± 32.4 g of flap and 74.7 ± 19.4 mL of lipofilling were used. Within 8 weeks after the procedure, the volume of the reconstructed breast decreased to 69.5 ± 7.5% and then plateaued. Seven patients needed a subsequent session of lipofilling to acquire adequate breast volume and projection. Notably, according to the BREAST-Q back scores, patients who underwent eeLD flap surgery were significantly more satisfied than those who underwent conventional LD musculocutaneous flap surgery using a skin paddle on the back at the same institution (82.8 ± 9.2 versus 62.6 ± 6.3; P < 0.0001). Despite the limitations in volume, eeLD flap plus lipofilling is advantageous because it does not leave a noticeable donor-site scar. Therapeutic, IV.

Volume Prediction of Extended Latissimus Dorsi Musculocutaneous Flap for Breast Reconstruction Using a Computed Tomography Volume-Rendering Technique with an X-ray Contrast Thread Marking.

The extended latissimus dorsi (ELD) musculocutaneous flap is one of the surgical techniques used for breast reconstruction. Preoperative preparation to determine the exact amount of flap tissue to be harvested is important to achieve a good outcome with autologous tissue reconstruction. However, few reports exist on objective preoperative volume prediction of ELD flaps. The purpose of this study was to quantify the elevated ELD volume as a preoperative plan. Patients who underwent immediate or delayed breast reconstruction with ELD flap after mastectomy between March 2015 and January 2022 are included. (1) The ELD flap was designed preoperatively, X-ray contrast thread was applied along the design, and CT imaging was performed in the same lateral supine position as the surgical position. 3D images were constructed, and the volume-rendering method was used to obtain the integrated volume. (2) Intraoperative ELD flap volume was calculated using the water displacement method. The correlation between (1) and (2) was examined. (1) The mean preoperative predicted value was 290.2 mL and (2) the mean intraoperative ELD flap volume was 298.3 mL. The correlation coefficient between the two volumes was 0.93, indicating that they were correlated. We could quantify the ELD flap volume using the volume-rendering method with X-ray contrast threads. This study could be a useful method for preoperative prediction planning of the ELD flap in breast reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Latissimus dorsi flap - the main force in breast reconstruction for breast tumor in Chinese population.

The latissimus dorsi flap (LDF) is the most commonly used autologous flap for breast reconstruction (BR) in China. We conducted this study to explore the current status of BR using LDF with/without implants. This study was a single-center retrospective study that included breast tumor patients who underwent LDF breast reconstruction at Fudan University Shanghai Cancer Center (FUSCC) between 2000 and 2021. We analyzed 4918 patients who underwent postmastectomy BR, including 1730 patients (35.2%) with autologous flaps. LDF was used for BR in 1093 (22.2%) patients, and an abdominal flap was used in 637 (13.0%) patients. The proportion of LDFs used in autologous BR patients decreased each year and dropped to approximately 65.0% after 2013 due to the increased use of abdominal flaps. Among these patients, 609 underwent extended LDF (ELDF) BR, 455 underwent LDF BR with implants, and 30 received a LDF as a salvage flap due to previous flap or implant failure. Patients who underwent ELDF reconstruction were older and had a higher BMI than those who received a LDF with implants. There was no significant difference in the mean postoperative hospital stay, neoadjuvant chemotherapy rates, or adjuvant radiotherapy rates between the two groups. Major complications requiring surgical intervention occurred in 25 patients (2.29%). There was no significant difference in the incidence of major complications between the two groups (P=0.542). LDF breast reconstruction is a well-developed and safe procedure. The duration of postoperative hospitalization nor the incidence of major complications was affected by implant use.

Useful Reduction Mammoplasty Technique in Oncoplastic Breast Surgery and Reconstruction.

A combination of the reduction mammoplasty technique and breast reconstruction allows surgeons to lift ptotic breasts through local flaps and skin reduction during surgery for breast cancer. This study presents a reliable course for the combination of partial and skin or nipple-sparing mastectomy with reduction-reconstruction surgery. Fifty-seven patients underwent a partial mastectomy before reduction mammoplasty of both breasts during the same time period between 2014 and 2021 at our institution and thirteen patients underwent skin or nipple-sparing mastectomy, breast reconstruction with an extended latissimus dorsi flap or silicone implant, and aesthetic reduction mammoplasty of the contralateral breast during the same time period. Additional photos were obtained preoperatively, immediately after the operation, and at one, three, six, and twelve months postoperatively. Patient satisfaction was evaluated preoperatively and postoperatively and postoperative complications were noted. Among the patients who underwent a partial mastectomy, the mean age was 45.18 ± 11.05 years, the mean body mass index (BMI) was 26.74 ± 3.53 kg/m2, and the mean preoperative right and left breast volumes were 663.85 (±28.12) cc and 664.34 (±37.13) cc, respectively, and the mean excised mass weight was 177.74 (±213.93) g. Among the patients who underwent a skin-sparing mastectomy, the mean age was 51.62 ± 8.96 years, the mean BMI was 26.91 ± 4.34 kg/m2, and the mean preoperative right and left breast volumes were 624.17 (±98.52) cc and 562.31 (±80.81) cc, respectively, and the mean excised mass weight was 618.05 (±338.17) g. Four patients (5.3%) in the partial mastectomy group had fat necrosis. The mean patient satisfaction score was higher postoperatively in both groups. Patients with breast cancer and large and/or ptotic breasts can successfully undergo reduction mammoplasty for both breasts immediately following partial mastectomy and nipple or skin-sparing mastectomy.

Combined Endoscopic Latissimus Dorsi Flap with Fat Graft versus Extended Latissimus Dorsi Flap for Breast Reconstruction

Combined Endoscopic Latissimus Dorsi Flap with Fat Graft versus Extended Latissimus Dorsi Flap for Breast Reconstruction

An original method of analysis of the breast contour curve with 3-dimensional imaging: Case series.

Introduction:Postoperative assessment of breast reconstruction results has become increasingly important. In this paper, a unique analysis method with 3-dimensional surface images of patients who were treated with immediate breast reconstruction is presented.Patient concerns:Five Japanese women were suspected of having breast cancer and visited our hospital for treatment.Diagnosis:Breast cancer was diagnosed by biopsy, mammography, ultrasonography, computed tomography, and magnetic resonance imaging.Interventions:Five patients underwent nipple/skin-sparing mastectomy, concomitant sentinel lymph node biopsy, and immediate breast reconstruction in our hospital. Three cases were reconstructed by extended latissimus dorsi flaps, one was reconstructed by a pedicled transverse rectus abdominis myocutaneous flap, and one was reconstructed by a deep inferior epigastric artery perforator flap. Three-dimensional photographs were taken 1 year postoperatively. The similarity of the breast contours between the reconstructed breast and the nonaffected opposite breast obtained from 3-dimensional images was analyzed. The calculated value is called the breast contour score.Outcomes:No recurrence was observed during the follow-up period in any cases. All cases could be analyzed by breast contour score to evaluate the breast shapes.Conclusion:The scores become a relative value that ranges from 0 (completely different) to 100 (completely the same). By expressing the score as a relative value, the breast contour score could help us understand the degree of breast symmetry more intuitively.

The extended latissimus dorsi flap in oncology breast reconstruction: Case report and literature review

Abstract The latissimus dorsi myocutaneous flap was one of the first methods of oncology breast reconstruction described. However, the standard latissimus dorsi flap alone often does not provide sufficient volume for breast reconstruction, it may have not been the first choice anymore. The design of an extended latissimus dorsi flap has involved including the parascapular and scapula fat fascia in addition to the lumbar fat for additional volume. The main advantage of the extended latissimus dorsi flap is that it can provide autogenous tissue to restore breast volume, it is suitable for Asian women whose breasts are not too large. The author reported the first case of breast reconstruction after mastectomy using the extended latissimus dorsi flap at Viet Duc University Hospital with a 5-year follow up and literature review. Keywords: Extended latissimus flap, breast reconstruction, breast cancer.

Aesthetic outcomes and complications following post-mastectomy radiation therapy in patients undergoing immediate extended latissimus dorsi flap reconstruction and implant insertion.

Complications of radiotherapy after implant-based reconstruction include capsular contracture development, seroma formation, and reoperation for implant removal or replacement. However, there is a lack of studies regarding aesthetic outcomes and complication rates following radiation therapy among patients undergoing latissimus dorsi (LD) flap-based reconstruction with implant insertion for volume shortage. The present study aimed to evaluate clinical and aesthetic outcomes of post-mastectomy radiation therapy (PMRT) among patients receiving both LD flap reconstruction and implant insertion. This study comprised 66 patients who underwent mastectomy and breast reconstruction between March 2014 and July 2019. Patient demographics and outcomes were compared among patients who did and did not receive PMRT. Aesthetic outcomes were compared using gross photographs. The incidence of complications, including seroma formation, flap necrosis, nipple-areola complex necrosis, hematoma development, and capsular contractures, was compared between groups. No differences in aesthetic outcomes using gross photos during outpatient follow-up were observed between the radiation and control groups. No significant difference in the frequency of complications was observed between groups. The use of implants and LD reconstruction are inevitable in a proportion of patients due to a lack of LD flap volume. For these patients, PMRT could be safe treatment option if the necessary precautions are implemented.

Thoracodorsal artery flaps for breast reconstruction-the variants and its approach.

Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

Immediate Reconstruction of Large Ptotic Breasts following Vertical Reduction Pattern Nipple-Sparing Mastectomy.

PurposeWomen with large and/or ptotic breasts are generally not considered candidates for nipple-sparing mastectomy because of concerns regarding the high incidence of postoperative complications including ischemic complications. Therefore, we adopted a vertical skin resection technique for nipple-sparing mastectomy, and obtained satisfactory results following immediate autologous breast reconstruction. In this study, we aimed to describe our operative technique and review its outcomes.MethodsBetween January 2010 and March 2017, immediate autologous breast reconstructions were performed in 28 patients with moderate or large ptotic breasts after nipple-sparing mastectomy using the vertical reduction pattern. Grade II ptosis was observed in 12 patients, and 16 patients were classified as having grade III ptosis.ResultsOf the 28 patients, 21 received abdominal free flap reconstruction. In the remaining 7 patients, extended latissimus dorsi flaps were used in conjunction with anatomic implants. The mean weight of the excised breast tissue in the 2 groups was 575 g and 482 g, respectively. Satisfactory esthetic outcomes without major complications were achieved in all patients. Similar vertical reductions or mastopexies in the contralateral breast allowed better postoperative adjustment for symmetry. There was only 1 case of complete nipple necrosis; however, the problem was solved with “skin banking.” No local recurrences or distant metastases were detected at follow-up (mean 18 months, range 4 months to 6 years).ConclusionTo enhance cosmetic outcomes in patients with large and/or ptotic breasts, the vertical skin resection pattern for nipple-sparing mastectomy can be used to achieve better breast shape while preserving the nipple-areola complex. Moreover, it can improve the esthetic outcome without compromising oncologic safety.

Comparisons of complications between extended latissimus dorsi flap and latissimus dorsi flap in total breast reconstruction: A prospective cohort study

BackgroundThe latissimus dorsi (LD) flap is one of the most popular techniques in breast reconstruction. Although numerous studies have not shown functional impairment of the shoulder after surgery, other studies have reported significant functional impairment, especially after extended LD flap reconstruction. The present study compared functional deficit and shoulder movement between extended LD and LD flap reconstruction. Materials and methodsBetween December 2015 and May 2018, this study enrolled 31 patients undergoing LD flap reconstruction. Data on patient demographics, operative details, morbidities, and degree of shoulder movement were collected. Outcomes were compared between the extended LD and LD flap groups. ResultsTwenty-one women and 10 women underwent LD flap and extended LD flap reconstruction, respectively. The median patient age was 43 years. No demographic data differed between groups. Seroma, especially around the back incision, was the most common complication (90.5% in the LD flap and 90% in the extended LD group). Five patients in the LD flap group and one patient in the extended LD flap group showed decreased shoulder range of motion (ROM) at 6 months post-operation. Only one patient in the LD flap group showed impairment based on American Shoulder and Elbow Surgeons Shoulder Score (ASES). The results did not differ significantly between groups; however, the LD flap group showed faster functional recovery. ConclusionLD flap reconstruction can be performed with a very low impact on shoulder function. We observed a slightly decreased ROM for both LD flap techniques, with no impact on functional outcome.

Comparative Study between Extended Latissimus Dorsi Flap and Skin Sparing Mastectomy with Subpectoral Silicone Implant

Abstract Background Breast cancer is the commonest malignancy in women. It is the most common cause of cancer death among women worldwide. The female breast is a potent symbol of maternity and femininity. For many years after a mastectomy, many women experience psychological distress and feel that her everyday life has been disputed. Objectives Extended LD flap and skin sparring mastectomy with subpectoral silicone implants are widely used in breast reconstruction. The current study is conducted to report our initial clinical experience with both techniques and better assessment of the cosmetic outcome and complications. Patients and Methods This study was held at Ain Shams University Hospitals between period (1/3/2018 – 31/1/2019) and the number of Participants were 30 Patients, Divided equally in to 2 Groups: group A had an extended latissimus dorsi flap, group B had skin sparring mastectomy with sub- pectoral silicone implant. This research is approved by ethics committee (IRB). Results We were able to conduct an excellent cosmetic outcome with 53.2% of the cases (16 patients) falling in excellent and good score groups. Another 46.7% (14 cases) which fall in fair and poor score groups. None of our cases have had an ugly score. Conclusion The combination of plastic surgery techniques with breast oncology surgery gives the surgeon a new tool for treatment of breast cancer. This approach has enabled us to increase the number and extend the indications of breast conserving surgery with wider margins offering safer oncologic control with more satisfactory cosmetic outcome.

The Modified Extended Fleur-De-Lis Latissimus Dorsi Flap for Various Complex Multi-directional Large Soft and Bone Tissue Reconstruction.

IntroductionLatissimus Dorsi (LD) myocutaneous flap is a workhorse flap for various large reconstructions. Variants described to increase its volume are referred to as extended LD flaps. The extended fleur-de-lis LD is one of these variants. We report the clinical outcomes using a modified extended fleur-de-lis LD flap for complex multi-directional soft and bone tissue defects.MethodsBetween 2010 and 2017, 29 patients underwent the modified extended fleur-de-lis LD flaps, whose sizes were between 120 cm2 and 442 cm2. The mean age was 47.55 ± 9.07 years. Locations of the defects included head and neck (nine cases), upper extremity (six cases), lower extremity (nine cases) and chest wall regions (five cases).ResultsOf the 29 extended fleur-de-lis LD flaps, 11 were pedicled and 18 were free flaps. A total of 10 flaps were osteomyocutaneous and 19 were myocutaneous. The mean vertical size of the harvested skin paddle was 30.72 ± 4.57 cm (range: 20-38), and the mean horizontal size of the skin paddle was 8.69 ± 0.80 (range: 7-10) cm, with the mean maximum horizontal extensions of the flaps being 16.03 ± 1.18 (range: 14-18) cm. The flap survival rates were 100%. One flap had distal partial loss (less than 5%). Donor site complications included seroma (1) and numbness (1), both of which were managed conservatively. The average follow-up time was 23.97 ± 7.19 months.ConclusionThe presented modified extended fleur-de-lis LD myocutaneous/osteomyocutaneous flap for reconstruction of multi-directional complex soft tissue and bone defects is a good and reliable option, with low donor site morbidity.

Shaping an Anatomical Breast Using Extended Latissimus Dorsi Flap and Lipofilling in Immediate Breast Reconstruction.

Although many attempts have been made to augment the volume of the latissimus dorsi (LD) myocutaneous flap in breast reconstruction, only a few studies on the shaping of the LD flap to achieve a natural native breast have been conducted. We introduce our novel method to reconstruct a naturally shaped breast by combining an extended LD myocutaneous flap with immediate lipofilling. The patients who underwent an immediate unilateral breast reconstruction with an extended LD myocutaneous flap and lipofilling were retrospectively reviewed. The extended LD myocutaneous flap in 180-degree rotation was combined with an immediate lipofilling procedure followed by suturing to reproduce the constant dimensions of a neobreast. A total of 45 patients with a mean age of 46 years and an average body mass index of 23.1 kg/m were enrolled. The average weight of the mastectomy specimens was 299.0 g. An average 18.8 × 8.7-cm skin paddle within the flap was harvested, and 71.0 mL of fat was injected into the flap. Donor site seroma was found in 9 patients, and no flap or fat necrosis was found. Our technique of extended LD muscle flap with lipofilling reproduced breasts with constant dimensions and appropriate width, height, and projection. Shaping the LD muscle flap is not difficult or unpredictable. This is a simple and easy technique to shape the LD flap and will provide surgeons with an additional autologous option for breast reconstruction.

Lipofilled Mini Dorsi Flap: An Efficient Less Invasive Concept for Immediate Breast Reconstruction.

The traditional extended latissimus dorsi flap technique, in addition to lipofilling, has been one of the main procedures used for breast reconstruction after mastectomy. However, to obtain excellent results, this technique requires a large muscle harvest and further lipofilling sessions. The lipofilled mini dorsi flap technique, performed in a single operation, appealed to us as a way to improve the traditional technique.We present our experience with the lipofilled mini dorsi flap technique in a new scenario. We performed breast reconstruction with a lipofilled mini dorsi flap in female patients with breast cancer who underwent mastectomy and immediate breast reconstruction with a lipofilled mini dorsi flap. The operative technique is detailed in this article. The results were evaluated by the patients and the surgical team. We performed 72 lipofilled mini dorsi flap procedures during breast reconstruction surgery from May 2017 to January 2019. Fifty-nine (81.9%) cases were immediate reconstructions. Complications, such as infection or necrosis of the flap, were not observed in this study. We noticed seroma and 1 case of infected lymphocele, which was drained.Body mass index (BMI) was directly related to postoperative dorsal seroma. The authors reported that greater BMI was associated with a higher seroma volume.Most patients evaluated their reconstruction as satisfactory. The surgical team evaluated most of the results as very satisfactory or satisfactory. There were no cases of unsatisfactory results reported either by the patients or the surgical team. The lipofilled mini dorsi flap technique is an efficient, elegant, and less invasive solution that is more easily and quickly performed and achieves excellent long-term results in the immediate breast reconstruction scenario. For the first time to our knowledge, lipofilling was used to reduce the extent of latissimus dorsi dissection. The postoperative follow-up was better tolerated by patients. This technique may be offered to patients regardless of oncological treatment. In our experience, the lipofilled mini dorsi flap method has become the primary technique for immediate breast reconstruction.

Surgical Intervention for Refractory Donor-Site Seroma After Immediate Breast Reconstruction with Latissimus Dorsi Flap.

Donor-site seroma persisting for > 3weeks is the most common complication of latissimus dorsi (LD) flaps for breast reconstruction after mastectomy. Conservative treatment is insufficient for refractory seroma resolution. We report the results of surgical intervention for refractory donor-site seroma. Between January 2012 and April 2018, 319 patients undergoing breast reconstruction using an LD flap at our hospital were treated with conservative therapy if seroma was found. Refractory seroma of > 3months' duration was observed in five patients (1.6%). Before surgery, the precise location and extent of the capsule were determined using chest computed tomography, and surgical intervention was planned. An en bloc capsulectomy was performed after confirming the internal capsule. Simultaneously, a quilting suture, bolster suture, and fibrin sealant were applied to prevent recurrence. The mean age of the patients with refractory seroma was 45.4 ( ± 7.3) years, and their mean body mass index was 31.0 ( ± 6.2) kg/m2. All patients underwent breast reconstruction with an extended LD flap or extended LD flap with a silicone implant after total mastectomy. During the follow-up period of ≥ 10.4months, a mean of 34.4 ( ± 10.4) needle aspiration procedures were performed, and a mean of 12.8 ( ± 2.2) cc of seroma fluid was removed each time. Intraoperatively, the formation of a capsule with a well-defined border was confirmed; all patients showed complete resolution of donor-site seroma within 4weeks after surgical intervention. Refractory donor-site seroma occurrence was rare in the cases assessed. Surgical intervention was successful in cases of refractory donor-site seroma unsuccessfully treated with conservative therapy and is thus one of the most effective methods for complete resolution of refractory seroma.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Identifying Preoperative Factors Associated with the Volume Discrepancy in Patients Undergoing Breast Reconstruction with the Extended Latissimus Dorsi Musculocutaneous Flap Coverage.

The latissimus dorsi (LD) flap is a versatile option for breast reconstruction. However, the indications are limited because of volume discrepancy between the breast and the flap. We conducted this study to identify preoperative factors associated with the volume discrepancy in patients undergoing breast reconstruction with the extended LD flap. A retrospective study was performed in 69 patients (69 breasts) who underwent breast reconstruction with the extended LD flap between March 2015 and March 2018. We evaluated age,body weight, height, preoperative body mass index (BMI), postoperative BMI, breast skin defect size, breast volume, flap volume, and volume discrepancy [breast volume - flap volume]. Mean age, height, body weight, preoperative BMI, postoperative BMI, skin defect size, breast volume, flap volume, and volume discrepancy were 45.6 ± 7.1, 157.8 ± 0.1, 59 ± 8.1, 23.7 ± 3.2, 23.5 ± 3.3, 16.5 ± 9.3, 252.2 ± 107.1, 229.4 ± 95.6, and 32.6 ± 31.4, respectively. Spearman's rank correlation coefficients indicated significant positive linear correlations between volume discrepancy and preoperativeBMI (correlation coefficient = 0.267, P = 0.027), volume discrepancy and breast volume (correlation coefficient = 0.472, P < 0.001), and between volume discrepancy and skin defect size (correlation coefficient = 0.609, P < 0.001). Stepwise multiple regression analysis yielded the following formula: predicted log volume discrepancy (ml) = 1.2891 + 0.0639 × skin defect size + 0.0025 × breast volume (R2 = 0.421). Skin defect size and breast volume were preoperative factors associated with volume discrepancy in patients who have undergone breast reconstruction with the extended LD flap. Considering these factors, we can predict the lack of volume and plan any necessary secondary procedures. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Retrospective observational study of breast reconstruction with extended latissimus dorsi flap following skin-sparing mastectomy.

The study was aimed to evaluate oncological safety and patient satisfaction in relatively late stage breast cancer patients who was treated with skin-sparing mastectomy (SSM) followed by breast reconstruction with an extended latissimus dorsi (LD) flap. Oncological safety, postoperative complications, and cosmetic results were retrospectively analyzed in patients who underwent extended LD flap breast reconstruction following SSM between October 2011 and August 2014. A total of 62 patients who underwent 63 breast reconstructions were enrolled in the study. Local recurrence rate was 1.6% over a median follow-up of 63 months. On final aesthetic assessment, 37 reconstructions were rated excellent, 19 good, 5 fair, and 2 poor. Reconstruction-related complications occurred in 22 patients (34.9%); these patients’ satisfaction scores were significantly lower than those of patients without complications (P < .05). Five patients developed shoulder movement limitation, and 2 had minor twitching and pain in the reconstructed breast. However, these patients did not find their problems disabling and were able to live normally. SSM followed by breast reconstruction with extended LD flap can improve patients’ postoperative quality of life and is as oncologically safe as total mastectomy even in patients with tumors of relatively late stage.