Extended Latissimus Dorsi Myocutaneous Flap Research Articles

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

Abstract Background 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. Objectives The aim of this study was to investigate the patient-reported long-term results after breast reconstruction with the extended LD myocutaneous flap. Methods 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. Results 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. Conclusions 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. Level of Evidence: 3

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.

P107 - Predictors of donor site seroma requiring aspiration in breast cancer patients undergoing total breast reconstruction with extended latissimus dorsi myocutaneous flap or latissimus dorsi myocutaneous flap with prosthesis

P107 - Predictors of donor site seroma requiring aspiration in breast cancer patients undergoing total breast reconstruction with extended latissimus dorsi myocutaneous flap or latissimus dorsi myocutaneous flap with prosthesis

The use of contralateral free extended latissimus dorsi myocutaneous flap for a tertiary failed breast reconstruction: Is it still an option?

Unsuccessful breast reconstruction management represents a complex challenge for the plastic surgeon. Although these events rarely occur, many patients are not suitable candidates for conventional flaps, because of either previous donor-site surgery or lack of sufficient tissue. In this study, a contralateral free latissimus dorsi musculocutaneous flap (CL-LDMF) was planned for correction of major lesions in the anterior chest wall. Twelve patients underwent secondary/tertiary breast reconstruction with CL-LDMF with a customized shape (horizontal, oblique, or "fleur-de-lis") depending on the amount of tissue necessary. The technique was indicated in patients with large thoracic defects who lacked a donor site and had undergone previous unsuccessful pedicled LDMF. The mean follow-up time was 42.5 months (range: 18-72 months). Five local complications occurred in four of the 12 patients. Dorsal dehiscence was observed in one, local wound infection in one, small partial CL-LDMF necrosis in one, and dorsal seroma in one patient. All cases of complications were limited and treated with a conservative approach except for one implant extrusion 4 months after reconstruction. No total flap loss was reported. All patients achieved a satisfactory thoracic and breast reconstruction. The results of this study demonstrate that free CL-LDMF is a reliable technique and should be considered in selected cases of tertiary reconstructions. The majority of complications were immediate, minor, and comparable to other reconstructive techniques. We believe that in selected patients, especially those who do not have available donor-site areas, free CL-LDMF is advantageous and should be part of the armamentarium of all plastic surgeons who deal with tertiary breast reconstructions.

Immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-sparing modified radical mastectomy in 61 cases

Objective To investigate the surgical method and therapeutic effects of immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-sparing mastectomy. Methods From January 2008 to July 2014, 61 patients with breast cancer were given immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-sparing mastectomy. Results All of the 61 patients obtained successful breast reconstruction without flap necrosis and serious complications. Followed-up from 12 to 78 months, all patients were no local recurrence, but distant metastasis was occurred in 4 cases and death in 1 case. The morphology of reconstructed breast was excellent in 93.4 % (57/61) cases. Conclusion Immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-sparing mastectomy is safe, easy to master and has few serious complications. The reconstructed breast has a natural and beautiful appearance and improves the quality of life. It does not affect postoperative adjuvant therapy. Most Chinese patients can obtain breast reconstruction without implant. This method is worth to spread. Key words: Breast neoplasms; Breast reconstruction; Extended latissimus dorsi myocutaneous flap; Nipple-sparing mastectomy

Subfascial Harvest of the Extended Latissimus Dorsi Myocutaneous Flap in Breast Reconstruction

Widespread adoption of the extended latissimus dorsi myocutaneous flap in breast reconstruction has been limited by donor-site complications. The dissection plane may be either above or below the superficial layer of the thoracolumbar fascia, which may be transferred with the flap or retained on the back skin flaps. The aim of this study was to investigate whether varying the plane of dissection improves donor-site morbidity and complications. A comparative analysis of consecutive women treated with extended latissimus dorsi myocutaneous breast reconstruction by a single surgeon (D.F.) between 2006 and 2012 was performed. Eighty patients were reviewed. Between 2006 and 2011, 47 patients were treated with traditional suprafascial harvest (group A); the subsequent 33 patients between 2011 and 2012 had subfascial harvest (group B), retaining the superficial fascia on the back skin flaps. When compared with group A, group B patients showed significant reduction in both mean number of seroma drainage events (p = 0.027) and mean total aspirated seroma volume, which was reduced by half (p = 0.006). Group B patients also reported significant reduction in donor-site pain (p = 0.041) and donor-site scar adherence to the chest wall (p = 0.026). No increases in flap or donor-site dehiscence, partial flap loss, or other minor or major complications were observed. The technique of subfascial harvest during autologous latissimus dorsi flap breast reconstruction significantly improves back donor-site morbidity without compromising flap survival. Therapeutic, III.

Vascular augmentation of an extended latissimus dorsi myocutaneous flap through an intercostal vessel: A preliminary report

The extended latissimus dorsi (LD) flap, which includes adipofascial tissue around the posterior iliac crest, is a good option to reconstruct a large breast. However, poor vascularity in the extended part may cause partial fat necrosis. To minimise this problem, vascular augmentation of the extended adipofascial part was performed. When dissecting under the LD muscle, a single perforator from the 11th intercostal vessels was secured and traced upwards along the rib. After the flap was transferred to the chest, the intercostal vessels were anastomosed to the serratus branches of thoracodorsal vessels. This vascular supercharged extended LD flap technique was applied for selected patients. Intraoperative angiography showed that the contrast medium injected into the intercostal artery spread across the lumbar adipofascial part of the flap. This implies that vascular supercharge through the 11th intercostal vessel promotes the vascularity of the extended LD flap and may help to reduce the flap complication rate.

11. Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat in immediate breast reconstruction of large breasted women after sparing mastectomies

11. Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat in immediate breast reconstruction of large breasted women after sparing mastectomies

9. Studies of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients

S 735 of the study will promote a more structured breast cancer surgical care and better patient information service. To our best knowledge, this is the largest related preoperative investigation in the English language literature and the first one in the Central and Eastern European region. 9. Studies of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients T. Kinoshita, T. Hojo, J. Suzuki, K. Jimbo, K. Taruno, S. Asaga, M. Yoshida, H. Tsuda 1 National Cancer Centre Hospital, Surgical Oncology Division, Tokyo, Japan National Cancer Centre Hospital, Pathology Division, Tokyo, Japan Background: Despite the increasing use of both sentinel lymph node biopsy (SLNB) and preoperative chemotherapy (PST) in patients with operable breast cancer, there is still limited information on the feasibility and accuracy of SLNB following PST. In this study, the feasibility and accuracy of SLNB for breast cancer patients with clinically negative lymph nodes after PSTwere investigated. In addition, we evaluated a new automated assay system for cytokeratin 19 mRNA, the one-step nucleic acid amplification (OSNA) assay (Sysmex), to detect lymph node metastasis of breast cancer after PST. Materials and methods: Between 2003 and 2008, 200 patients with Stage II and III breast cancer previously treated with PST were enrolled in this study. The eligible criteria for PST were (a) primary tumor > 3cm or (b) positive axillary lymph node status on initial examination. FNA biopsy was performed for clinically or ultrasonographically suspicious axillary lymph nodes. The patients then underwent SLNB, which involved a combination of intradermal injection over the tumor of radiocolloid and subareolar injection of blue dye. This was followed by Level I/ II axillary lymph node dissection (ALND). Surgically obtained 84 lymph nodes from 21 breast cancer patients received PST were examined with both OSNA assay and HE five hundred & seventy patients of stage I to III breast carcinoma have autologous breast reconstruction with modified extended LDF with added vascularised chest wall fat; 47% had SSM and the remaining had NSM. Age ranges from 23 to 53 years (median 1⁄4 40.5). Results: Subjective patient satisfaction was excellent in 71%, good in 20%, fair in 7% & poor in 2% of cases. Bilateral size & shape symmetry are excellent in 56%, good in 26%, fair in 12% & poor in 6% patient. The overall RT-related complications are 9 %, the most common complications are skin burns (5%) & fat necrosis (4%). Patients are followed for mean follow up of 75.5 months (2-96). Conclusion: Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat is a single stage totally autologous breast reconstruction allows reconstruction without the additional cost of an implant, many complications of synthetic implants, micro vascular procedure second stage surgery or surgical manipulation in the other breast. In addition the overall survival & local recurrence rates were similar to MRM.

Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

510 Modified Extended Latissimus Dorsi Myocutaneous Flap with Added Vascularised Chest Wall Fat in Immediate Breast Reconstruction of Large Breasted Women After Sparing Mastectomies

510 Modified Extended Latissimus Dorsi Myocutaneous Flap with Added Vascularised Chest Wall Fat in Immediate Breast Reconstruction of Large Breasted Women After Sparing Mastectomies

512 Intraglandular Flap Technique with Racquet Incision for Cancers Located in Upper Outer Quadrant of the Breast

conservative breast surgery, and thirty patients had myomammary flap reconstruction. Age ranges from 23 to 63 years (median = 41.7). Results: The oncologic outcome of extended LDF with added vascularized chest wall fat in the reconstruction of the huge breast was superior to myomammary flap with near equal oncologic outcome. In special situation; the therapeutic reduction mammoplasty is employed with better outcome than conventional conservative breast surgery as the safety margin which in the first is wider (5−10 cm) and more confidential than the conventional conservative breast surgery (CBS), the aesthetic outcome is better than CBS but the operative time and hospital stay are longer than CBS. In comparison to sparing mastectomies with extended LDF with added vascularized chest wall fat which is aesthetically and oncologically near equal to therapeutic reduction mammoplasty. Conclusion: Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat is a single stage totally autologous breast reconstruction allows reconstruction without the additional cost of an implant, many complications of synthetic implants. Therapeutic reduction mammoplasty is an oncologically safe surgical procedure in special situations that yields satisfactory aesthetic results and low morbidity in large breasted women with cancer.

Extended latissimus dorsi myocutaneous flap for breast reconstruction: analysis of 30 patients

Extended latissimus dorsi myocutaneous flap for breast reconstruction: analysis of 30 patients

Dealing with the non-healing; donor site defect following latissimus dorsi myocutaneous flap in breast reconstruction

We present two cases of donor site morbidity following immediate breast reconstruction using the extended latissimus dorsi myocutaneous flap. Early post operative dehiscence occurred in both cases, followed by a prolonged period of expectant and conservative management. Plastic surgical intervention involved exploration and removal of significant epithelial lined cavities and reconstruction using local flaps to solve this complication.

Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese

Objective: Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population.Methods: Patients who had undergone immediate postmastectomy breast reconstruction by extended latissimus dorsi flap without prosthesis were retrospectively studied. Surgical complications, aesthetic result and patient satisfaction were evaluated.Results: Ten Asian patients (nine Chinese and one Filipino) underwent extended LD flap for breast reconstruction after mastectomy. There was no total or partial flap failure. Operative complications included seroma in one patient and minor wound edge slough at back wounds in two patients. Simultaneous seroma and minor donor wound slough occurred in another patient. Aesthetic outcome was excellent (n = 5), good (n = 4) and poor (n = 1). Patient satisfaction with the procedure was very satisfied in four, satisfied in four and dissatisfied in two, respectively. All but two patients would recommend the same procedure to their friends or relatives.Conclusion: Extended LD flap can reliably achieve pleasing results with low morbidity. It has more potential to become a competitive alternative to transverse abdominis myocutaneous flap in most Chinese women for postmastectomy reconstruction.

Skin‐Sparing Mastectomy with Immediate Breast Reconstruction by a New Modification of Extended Latissimus Dorsi Myocutaneous Flap

The introduction of skin-sparing mastectomy has revolutionized both breast cancer surgery and breast reconstruction. Latissimus dorsi myocutaneous flap is a versatile flap that is gaining renewed popularity with the development of flap modifications and the continued recognition of its reliability and safety. We report our results with a new modification of the extended latissimus dorsi flap after skin-sparing mastectomy for breast cancer. From January 2002 to January 2006, 140 patients of breast carcinoma had unilateral skin-sparing mastectomy and immediate breast reconstruction. A total of 132 cases of invasive duct carcinoma and eight cases of invasive lobular carcinoma are included. Age ranged from 27 to 53 (median, 40.5) years. Tumor stage was stage I in 22 cases, stage II in 100 cases, and stage III in 18 cases. We performed a new modification to the standard extended latissimus dorsi flap, which allowed us to obtain enough autologous tissue to reconstruct the relatively large breast of the Egyptian women without implant. The postoperative aesthetic results and donor side morbidity, including contour deformity and scaring, were examined. We applied both an objective and subjective aesthetic result monitoring. Aesthetic grading results of breast reconstruction were excellent in 85, good in 42, fair in ten and poor in three cases. Both flap and donor site complications were minor. Patients were followed for a median of 32.4 (range, 12-48) months. During this period of follow-up, no episode of local or distant failure was observed. Skin-sparing mastectomy with immediate breast reconstruction using our new modification of extended latissimus dorsi flap allows single-stage, totally autologous reconstruction with satisfactory aesthetic results and low morbidity.

Immediate breast reconstruction – a review of indications, techniques and results

BACKGROUND: It has only been during the last decade that immediate breast reconstruction has become accepted as an integrated part of the treatment concept of breast cancer in Austria. The involvement of the plastic surgeon in the planning of treatment at the time of the diagnosis of breast cancer is still far from standard. The aim of this review article is to make it more widely known that immediate breast reconstruction is a choice for the majority of women undergoing complete breast removal or greater disfiguring resections of the breast gland and does not have any negative influence on the oncological late outcome. METHODS: On the basis of a review of the international literature and our own prospective studies on breast reconstruction, the actual indications and contraindications for immediate reconstruction are outlined. Having analysed patients of the Division of Plastic and Reconstructive Surgery at the Department of Surgery at the Medical University of Vienna for the last 15 years, the evolution of immediate breast reconstruction and of the methods applied is described. Special attention is paid to the biology and the course of the tumour disease, to the possible interference with adjuvant therapies, to the influence of age, and to the selection of the operative technique depending the individual situation. RESULTS: All major studies of local recurrence rate and survival rate after immediate breast reconstruction have ruled out any negative effect on the oncological course. Therefore information on the possibility of immediate breast reconstruction has to be passed on to every breast cancer patient at the time of diagnosis. This information has to include the whole range of techniques offered by plastic surgeons for breast preserving surgery, from the local glandular mammaplasty, the reduction mammaplasty for tumor resections in bigger breasts, the partial reconstruction with a myocutaneous latissimus dorsi flap to the reconstruction with a breast implant. In the case of a mastectomy, usually as skin-sparing mastectomy, again the whole spectrum of reconstructive approaches has to be discussed with the patient from the very beginning: the Deep Inferior Epigastric Perforator Flap (DIEP – flap), the Transverse Rectus Abdominis Myocutaneous Flap (TRAM – flap), and the extended latissimus dorsi myocutaneous flap for autologous breast reconstruction, or with the involvement of a breast implant. The immediate breast reconstruction with autologous tissue has become the procedure of first choice, because the disadvantages of the use of implants in the case of necessary postoperative irradiation therapy can be avoided. CONCLUSIONS: Information on all reconstructive possibilities should be passed on by the plastic surgeon to the patient needing a resection of the whole or a greater part of the breast because of breast cancer at the time of diagnosis so as not to miss the chance of immediate reconstruction if preferred by the patient.

Cosmetic reconstruction after resection of breast cancer: use of the ELD-MC flap and EVRAM flap

Breast reconstruction following the resection of breast cancer with inadequate residual chest-wall tissue may be performed with an implant or a myocutaneous flap, such as the latissimus dorsi or a rectus abdominis. Among a variety of operative procedures, each method has advantages and disadvantages. The insertion of a silicone-bag prosthesis is the easiest method, but the prosthetic implant sometimes has complications, such as unfavorable capsular contracture formation around the implant, rupture, infection, or exposure. We therefore use an extended latissimus dorsi myocutaneous (ELD-MC) flap with some amount of surrounding subcutaneous fat from the lumbar area, and avoid the use of any implant with an MC flap. Also, for the reconstruction and correction of infraclavicular and axillary depression, we use the extended vertical rectus abdominis myocutaneous (EVRAM) flap. This method uses the skin and fat on both sides of the umbilicus as a lenticular flap vascularized by only one of the rectus abdominis muscles. The patients are satisfied with the outcome because symmetry and good breast volume can be obtained. There have been no functional or anatomical defects of the donor area. No abdominal hernia after an EVRAM flap has resulted to date. Both the ELD-MC and EVRAM flaps can be successfully used for cosmetic breast reconstruction after the resection of breast cancer.

Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery.

Closure of thoracolumbar wounds and vertebral osteomyelitis after scoliosis surgery often proves difficult due to tautness and lack of usable tissue, and the resulting dead space containing metallic fixation devices is predisposed to infections and complications. The authors present their experience with 33 patients in whom massive thoracolumbar wounds and vertebral osteomyelitis developed following scoliosis surgery. Postoperative infection, due to the lack of vascularized tissue and presence of metallic hardware near the wound, is common and extremely counterproductive; within these cavernous wounds lie infected vertebrae, metallic hardware, and bone graft. The use of a modified and extended latissimus dorsi myocutaneous flap to close and supply blood to wounds in the lower thoracic and thoracolumbar areas is described. This surgical approach, predicated on effective débridement along with reconstruction by transposition of vascularized tissue, allows the wound to close and drastically decreases the risk of postoperative infection. Furthermore, for wounds already infected, the procedure allows for closure and increased blood supply to the area, thus giving the wound a much greater ability to heal. For wounds involving the lumbosacral area, the authors combine this with a transposed gluteus maximus muscle flap to obtain coverage over the caudal extent of the wound. In this study, all flaps accomplished their intended purpose: to secure the healing of once-infected wounds and to allow preservation of orthopedic instrumentation and bone graft. Follow-up revealed no flap losses, pseudarthroses, or loss of orthopedic instrumentation in the study group.

Autologous Breast Reconstruction with the Extended Latissimus Dorsi Flap

The extended latissimus dorsi myocutaneous flap can provide autogenous tissue replacement of breast volume without an implant. Nevertheless, experience with the extended latissimus dorsi flap for breast reconstruction is relatively limited. In this study, the authors evaluated their experience with