Latissimus Flap Research Articles

The Combined Bra-Line Back-Lift Latissimus Flap (BLBL-LAT Flap) for Aesthetic Breast Reconstruction and Simultaneous Back Contouring.

The latissimus dorsi pedicled ('LAT') flap has been a workhorse flap for breast reconstruction for many decades. The asymmetric back scar has been a major source of complaint. In patients with excess back adiposity, we can utilize the skin paddle harvest to improve back contour. We combined the principles of the esthetic bra-line back-lift with the LAT flap to provide simultaneous improvement of both posterior upper trunk adiposity and skin excess, which together form 'back rolls', using a concealed scar. To establish a new surgical technique of combined bra-line back lift with latissimus dorsi flap ('BLBL-LAT flap') for esthetic breast reconstruction. This was an IRB-approved retrospective single-surgeon study performed in a national cancer center. We included patients undergoing breast reconstruction using combined BLBL-LAT flap between 2015 and 2023, with a minimum of 6 months follow up. 106 female patients underwent 110 breast reconstructions using BLBL-LAT flap. 75% of patients had prosthesis placement and 25% of patients were 100% autologous. Complication rates were low: 4/106 patients (3.8%) had seroma, needing surgery. Of the 78 reconstructions with implants, 3 (3.8%) had periprosthetic implant infection. One (<1%) patient had partial flap loss and no patients had complete flap loss. Four patients had bilateral BLBL-LAT flap reconstruction. Two unilateral breast reconstruction patients came back for successful symmetrizing bra-line back-lift (without LAT flap breast reconstruction). The BLBL-LAT flap allows breast reconstruction and simultaneous improvement in back contour, using a scar that can be concealed in a bra. This two-for-one procedure is of particular benefit for patients with high BMI who often have unwanted excess adiposity and laxity of the back. Since this patient population are high risk for free tissue transfer, we propose that the BLBL-LAT flap should be considered the first-line method of autologous breast reconstruction in higher BMI patients.

3D modeling of anterior 2/3rds glossectomy reconstruction: A volume based donor site evaluation

ObjectiveAnterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location. We sought to correlate flap thickness at different donor sites with patient BMI to determine optimal donor site selection. MethodsPatients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI. ResultsIn 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm3. Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm3), followed by latissimus (105.6 cm3), parascapula (97.8 cm3), and ALT (60.5 cm3). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89–92 % of native tongue) and parascapular flap (85–95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129–135 % of native tongue volume). ConclusionThe DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.

Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction

BackgroundAutologous breast reconstruction is associated with significant pain impeding early recovery. Our objective was to evaluate the impact of replacing surgeon-administered local infiltration with preoperative paravertebral (PVB) and erector spinae...

The Full Continuum of Robotic Breast Surgery: Robotic-assisted Mastectomy, Robotic DIEP Flap, and Robotic Supermicrosurgery

Summary: In recent years, robotic surgery has rapidly expanded to improve surgical outcomes in a variety of surgical subspecialties. Although plastic surgery has taken longer to integrate robotic surgery into practice, the advantages of robotic-assisted surgery, including improved visualization and resolution, minimally invasive approaches, and the ability to surpass human precision and scale, have driven its more recent adoption into plastic surgery. Currently, procedures performed with robotic assistance that are considered part of the continuum of surgical treatment of breast cancer include robotic-assisted nipple-sparing mastectomy, reconstruction with the robotic latissimus dorsi flap or the deep inferior epigastric artery perforator flap, and robotic microsurgery for the flap anastomosis and/or the surgical treatment of lymphedema. The authors provide an overview of robotic surgery and how it has been integrated into the field of plastic surgery, as well as a review of the most common procedures within the field where robotic assistance can be incorporated: nipple-sparing mastectomy, robotic latissimus flap, robotic deep inferior epigastric artery perforator flap breast reconstruction, and microvascular anastomoses.

Robotics in Microsurgery and Supermicrosurgery.

Microsurgery has changed the ability to perform highly precise and technical surgeries through the utilization of high-powered microscopes and specialized instruments to manipulate and repair anatomical structures as small as a few millimeters. Since the first human trials of robotic-assisted microsurgery in 2006, the expansion of microsurgery to supermicrosurgery (luminal diameter less than 1 mm) has enabled successful repair of previously inaccessible structures. Surgical robotic systems can offer two distinct operative advantages: (1) minimal access surgery-by entering body cavities through ports, flap harvest can be redesigned to affect a minimally invasive approach for flaps such as the rectus abdominis muscle, the latissimus flap, and the deep inferior epigastric perforator flap; and (2) precision-by eliminating physiologic tremor, improving ergonomics, increasing accessibility to difficult spaces, and providing motion scaling, precision is significantly enhanced. Robotic-assisted microsurgery is a promising application of robotics for the plastic surgeon and has played an important role in flap harvest, head and neck reconstruction, nerve reconstruction, gender-affirming surgery, and lymphatic reconstruction-all the while minimizing surgical morbidity. This article aims to review the history, technology, and application of microsurgery and supermicrosurgery in plastic surgery.

Systematic Review of Patient-Reported Outcomes and Complications of Pedicled Latissimus Flap Breast Reconstruction.

The latissimus dorsi (LD) flap is a reliable option for breast reconstruction. This is particularly true in patients with contraindications to abdominally based autologous breast reconstruction. A systematic review of patient satisfaction and health related quality of life following LD breast reconstruction using the BREAST-Q survey was conducted. The scope of the review was to determine the degree of patient satisfaction following the procedure and to examine how patient satisfaction from the pedicled LD flap compares to other breast reconstructive procedures. A literature search on BREAST-Q in LD flap reconstruction was performed. Only articles written in English and in published peer-reviewed journals were included. Studies with less than 20 patients in their sample and those with a follow-up period of less than 1 year were excluded. Five articles representing 331 patients were reviewed, including one case-control study and four retrospective cohort studies. Level of evidence was either III (4) or IV (1). The average age was 53 with average body mass index of 25. Most reconstructions were delayed (67%) and unilateral (88%), and most patients required radiation (79%). The average length of follow-up was 36 months, and the response rate was 75%. Overall, patients who underwent LD flap reconstruction reported favorable outcomes in satisfaction domains and quality of life domains with few complications. A meta-analysis also demonstrated higher satisfaction in LD flap without implants compared with LD flap with implants. Patient-reported outcomes following LD breast reconstruction compare favorably with other techniques of breast reconstruction.

Cultured Skin Autograft in Subtotal Pediatric Scalp Avulsion.

Pediatric scalp avulsions represent a reconstructive challenge because of the unique features of scalp tissue. When microsurgical reimplantation is not feasible, alternative approaches such as skin grafting, free flap transfer with latissimus flap, or tissue expansion are considered. Generally, there is no consensus regarding management of this trauma, and, oftentimes, multiple reconstructive techniques may be needed for definitive coverage. This case study describes the reconstruction of a pediatric subtotal scalp avulsion using a dermal regeneration template and novel autologous homologous skin construct. This case was complicated by the absence of original tissue for reimplantation, excessive size of the defect relative to body habitus, and family concerns for future hair-bearing function. The reconstruction successfully provided definitive coverage and significantly reduced the size of the donor site and associated compilations. However, the hair-bearing potential of the tissue has yet to be determined.

D146. What Nipple Reconstruction Can Tell Us About the Latissimus Dorsi Flap Subdermal Plexus

PURPOSE: We previously presented our experience of local flap nipple reconstruction over various breast mound reconstructive modalities. Despite a conception that nipple reconstruction may be more reliable over flap beds than mastectomy skin, we preliminarily found that C-V flap designs on latissimus dorsi flap reconstructed breast mounds experience a 10-fold higher necrosis rate compared to implants or abdominally based flaps, leading the senior author to change his practice to exclusively base C-V flaps laterally over latissimus flaps. METHODS: A retrospective review was conducted from 2012 to 2022 of patients who underwent primary C-V subdermal pedicle flap nipple reconstruction by a single surgeon over implant-based, latissimus dorsi, and abdominally-based flap breast reconstruction. Demographics, C-V flap orientation, and nipple necrosis complications were recorded. RESULTS: Four hundred ninety-three nipple reconstructions in 312 patients were included, consisting of 41 latissimus dorsi, 45 deep inferior epigastric perforator, and 51 pedicled transverse rectus abdominis muscle flaps, 203 staged expander-to-implant, and 125 direct to implant reconstructions. In the latissimus cohort, 24.3% of patients experienced postoperative necrosis versus 1.6% to 5.9% among other reconstructive modalities. More interestingly, since the implementation of a laterally-based C-V flap on latissimus breast mounds, the complication rate fell to 10%. CONCLUSION: Our initial data, confirmed with the latest update, seem to highlight the unique subdermal plexus directionality in the latissimus dorsi flap compared to all other common reconstructed breast mounds. Extrapolated, these findings may imply a potential directional relationship between the subdermal vascular plexus and the axial pedicle of the underlying flap.

Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas

(1) Background: Resection of soft-tissue sarcomas (STS) of the upper extremity can result in substantial functional impairment with limited options for functional reconstruction. Free functional latissimus flaps have been utilized to restore function of the thigh; however, there is limited data on the use of latissimus flaps for functional reconstruction in the upper extremity. As such, we sought to evaluate our institutional experience with these flaps. (2) Methods: We reviewed ten (seven male; three female; and a mean age of 63 years) patients undergoing soft-tissue sarcoma resection involving the triceps (n = 4), biceps (n = 4), and deltoid (n = 2) reconstructed with a pedicled functional latissimus flap. All surviving patients had at least 1 year of follow-up, with a mean follow-up of 5 years. (3) Results: The mean elbow range of motion and shoulder elevation were 105° and 150°. The mean Musculoskeletal Tumor Society score was 88%, and the muscle strength was four. Four patients had a recipient site wound complication. There were no flap losses. One patient sustained a radiation-associated humerus fracture 5 years postoperatively, treated nonoperatively. (4) Conclusions: Although early complications are high, pedicled functional latissimus flaps allow for wound coverage, potential space obliteration, and restoration of function in the upper extremity following resection of large soft tissue sarcomas.

Risk stratification of surgical-site outcomes by BMI and flap type in autologous breast reconstruction

Afflicting 2 million lives annually worldwide, breast cancer remains devastating. This study utilized a continuously updated network of electronic medical records (TriNetX Inc, Cambridge, MA) for analysis of 90-day postoperative outcomes of autologous breast reconstruction by increasing body mass index (BMI). The deidentified electronic medical records (EMRs) of 29,453,000 females, age 18-99 years, were retrospectively screened from 45 healthcare organizations. A combined cohort of 7136 patients undergoing autologous breast reconstruction via transverse rectus abdominus muscle (TRAM), deep inferior epigastric perforator (DIEP), or latissimus flap was categorized by BMI into 5 subgroups: normal (n=3568), overweight (n=1239), class I (n=1166), class II (n=807), and class III (n=356) obesity. The normal BMI cohort was then compared with each elevated BMI cohort. BMI strata were analyzed for risk of surgical-site occurrences within 90 days of surgery using CPT codes. Stringent propensity score matching was performed. For the combined group (N=7136), significant linear increases in risk were observed with increasing BMI for infection (risk ratio [RR] 1.39-2.91,p<0.05) and dehiscence (RR 2.65-5.17, p<0.05). Similar linear increases were observed for the abdominally based group (N=5454) for infection (RR 1.45-2.47, p<0.05) and dehiscence (RR 2.54-4.77, p<0.05). For DIEP (N=4874), near-linear increases were observed for infection (RR 1.60-2.79, p<0.05) and dehiscence (RR 1.57-5.59, p<0.05). For TRAM (N=714), significant increases were observed for seroma, infection, dehiscence, deep vein thrombosis (DVT), sepsis, and PE while increased risks of seroma, DVT, PE, and hernia were observed for latissimus (N=1380). Regardless of flap type, our analysis suggests that a BMI>39.9 is the inflection point beyond which it may be beneficial not to perform autologous breast reconstruction. Limitations include this study's retrospective nature; thus, future prospective studies would be beneficial.

Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten.

The objective of this article is to review options for regional pedicled reconstruction for large head and neck defects in a salvage setting. Relevant regional pedicled flaps were identified and reviewed. Expert opinion and supporting literature were used to summarize and describe the available options. Specific regional pedicled flap options are presented including the pectoralis major flap, deltopectoral flap, supraclavicular flap, submental flap, latissimus flap, and trapezius flap. Regional pedicled flaps are useful options in a salvage setting even for large defects and should be in the armamentarium of any reconstructive head and neck surgeon. Each flap option carries specific characteristics and considerations.

Toward Drainless Breast Reconstruction: A Pilot Study.

Background:Implant-based breast reconstruction with immediate tissue expander placement is the predominant form of breast reconstruction in the United States. Closed-suction drains are frequently employed to minimize seroma accumulation, although they carry the risk of serving as a port of entry for bacteria, posing a concern in the presence of implanted materials such as breast implants or acellular dermal matrix. Introduction of a dual-port tissue expander designed to facilitate the collection and removal of seroma fluid provides a new way of performing breast reconstruction without external drains.Methods:We conducted a pilot study using the AlloX2 dual-port expander on five consecutive patients to demonstrate feasibility of this approach at Cedars-Sinai Medical Center by the two senior authors (E.R. and D.K.).Results:Patients averaged seven clinic visits before they were ready for expander exchange, totaling a mean of 137.5 days. Patients averaged 1.9 clinic visits before output was less than 40cm3 (1.6 for right breasts and 2.2 for left breasts), with two of the patients never reaching that output. There was one complication; a single patient had unilateral flap necrosis and implant exposure due to excessively large breasts and thin skin flaps, necessitating expander removal and latissimus flap reconstruction. The other four patients underwent successful implant reconstruction.Conclusions:This pilot study demonstrates the feasibility of breast reconstruction without external drains using a dual-port expander with built-in seroma reservoir. From these results, it is apparent that dual-port tissue expanders with built-in seroma reservoir offer a safe and effective way to perform breast reconstruction without drains in appropriately selected patients. A larger prospective cohort will be needed to definitively demonstrate lower infection and reconstructive failure rates.

Free Functional Latissimus Dorsi Reconstruction of the Quadriceps and Hamstrings following Oncologic Resection of Soft Tissue Sarcomas of the Thigh

Background Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. The purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. Methods Twelve patients with a sarcoma involving the hamstring (n = 6), quadriceps (n = 5), or combined (n = 1) defects which included multiple muscle groups were reviewed. This included 9 males and 3 females with a mean age and body mass index of 56 ± 12 years and 31.3 ± 5.7 kg/m2. Results The mean defect volume and operative time was 3,689 ± 2,314 cm3 and 587 ± 73 minutes. Following reconstruction, the mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. Seven (58%) patients sustained a complication, namely, delayed wound healing (n = 2). Conclusion Although there was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh.

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.

Lower Pole Breast Reconstruction Using Muscle-sparing Latissimus Dorsi Flap in Postburn Breast Deformity.

Background:Full-thickness burns of the anterior chest wall during childhood are a devastating problem that results in significant distortion of the developing breast. This deformed burnt breast represents a serious aesthetic problem, and can lead to functional impairment as well as severe emotional trauma for patients.Methods:Patients with postburn scarring affecting the lower pole of the breast were included. Only patients with small to medium-sized breasts were targeted. The lower breast pole was reconstructed using muscle-sparing latissimus dorsi flap. All patients had been subjectively assessed, including overall patient satisfaction regarding breast aesthetics, donor site morbidity, and functional deficits of latissimus dorsi muscle, 3 months postoperatively.Results:Six patients (seven breasts) were included in this study. Muscle-sparing latissimus dorsi flap was used to reconstruct lower breast pole in all patients. A horizontally-oriented skin paddle was used in five patients, whereas a vertically oriented skin paddle was used in one patient. Average patient satisfaction was 9.1 (SD 0.6) for the reconstructed lower breast pole. For the donor site, average overall satisfaction was 9.1 (SD 0.8). Latissimus dorsi muscle function was objectively confirmed in 90% of cases after 3 months postoperatively. Patients had an average score of 3.9 (SD 0.4) for the activity score as well.Conclusions:The muscle-sparing latissimus dorsi flap is a good reconstructive tool for lower breast pole in postburn breast reconstruction. It has a reliable versatile skin paddle that can resurface the whole lower breast pole, while avoiding many of the latissimus flap morbidities.

Obesity and the Latissimus Dorsi Flap: A Radiologic Study.

Introduction: The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Methods: Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography-guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. Results: A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted R2 of 0.682, P < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted R2 of 0.553, P < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. Conclusion: The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.

Technical Considerations and Clinical Applications of the Free Anterior Branch Split Latissimus Dorsi Flap.

The free anterior branch split latissimus dorsi flap has a reliable anatomy and advantages over the traditional latissimus dorsi flap. By preserving the posterior branch of the thoracodorsal nerve, morbidity at the donor site is reduced, preserving shoulder strength. The purpose of this article is to review our experience with the split latissimus flap, describe our surgical technique, and finally review representative cases of reconstruction in different anatomical regions. From April 2017 to October 2020, 39 free split latissimus flaps were performed at a single center. Flaps were performed for coverage in the upper extremity (n = 2), lower extremity (n = 32), and head and neck (n = 5). Flap success rate was 97.4%. Mean dimensions of the flap were 17.0 × 8.3 cm, with a mean area of 145 cm2. The flap has a broad application and can be utilized in many different reconstructive scenarios including for coverage of defects in the extremities, trunk, and head and neck.

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

Introduction Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay. Reconstruction of these wounds presents a challenge, as the spine is dependent on these implants for stability and must be maintained throughout the wound dehiscence treatment protocol. We describe a method for extending the thoracodorsal pedicle with an arteriovenous loop to permit an increased excursion of the latissimus dorsi muscle in patients with exposed implants and present the results of this procedure.Materials and Methods A retrospective review of patients treated with a latissimus free flap with saphenous vein pedicle extension for posterior spinal wounds from 2010 to 2020 were reviewed. Patient charts were reviewed for demographic information including comorbidities, previous spine operations, wound size and location, and postoperative complications including total flap loss, flap dehiscence, and need for secondary surgery.Results Six patients were identified who underwent a total of eight extended pedicle free flaps. Mean age was 64.8 years with a mean follow-up of 12.3 months (range, 6–20 months). Four wounds were in the cervicothoracic region with two wounds in the cervical region. Mean number of previous spine surgeries was 3.5 (range, 2–4). Mean wound size was 189 cm2 with a mean vein graft length of 28 cm. Wound coverage was successful in five of six patients. Major complications occurred in five of six patients. Total flap loss occurred in two patients (33%) and both underwent a second extended latissimus flap from the contralateral side. Three patients developed postoperative flap dehiscence which resolved with regular dressing changes.Conclusion Extended pedicle latissimus flaps are an effective treatment for posterior spine wounds but are associated with a high complication rate, secondary to medically complex patients with multiple prior surgeries. Careful patient selection is critical for success.

Expanding the Progressive Tension Suture Concept: A Study of Its Utility in Body Contouring Procedures.

Seroma is one of the most common complications following body contouring. Progressive tension sutures (PTSs) have been shown to decrease the seroma rate following abdominoplasty, component separation, and facelifts and following latissimus flap and deep inferior epigastric artery perforator flap harvest. The aim of this study was to investigate the effects of PTS techniques and their impact on the seroma rate in body contouring flap procedures. A retrospective review was performed of all patients undergoing a flap procedure (defined as any procedure that produces a dead space and subsequent susceptibility to seroma) by a single surgeon at a single institution over 3 years. All patients/procedures utilized PTS techniques, as is routine in the surgeon's practice. No drains were used. Patient demographics and complications, including seroma, were tracked. A total of 441 flap procedures were performed in 351 patients over the 3-year study period. These procedures comprised 305 abdominoplasties, 68 lower body lifts, 17 medial thigh lifts, 36 brachioplasties, and 15 torsoplasties. PTSs were used in all procedures. No drains were utilized. Complications occurred in 72 procedures (16.3%), with the most common complication being minor wound dehiscence without infection. There were no cases of seroma. PTSs represent an effective technique for reducing the seroma rate, eliminating the potential space and promoting tissue adherence in flap procedures for body contouring. This is the first study of its kind demonstrating the use and role of this technique in body contouring procedures beyond the scope of abdominoplasty.

Trends of Breast Reconstruction in Medicare Beneficiaries

BACKGROUND: In April 2014, the Centers for Medicare and Medicaid Services released millions of billing records for over 880,000 healthcare providers in an effort to improve the transparency, accountability, and affordability of the US healthcare system. This study was performed to analyze the overall Medicare landscape with respect to surgeons, beneficiaries, services, and reimbursements in the setting of breast reconstruction. METHODS: This is a retrospective analysis of publicly available Medicare utilization and payment data for surgeons who provided services to Medicare beneficiaries between January 2012 and December 2017. Breast reconstruction Current Procedural Terminology (CPT) codes were queried using the Medicare Payment and Utilization Database. Statistical significance was computed using a one-way analysis of variance and Levene’s test was used to confirm the homogeneity of variances. RESULTS: Data included trends in the number of breast reconstructions over time and average Medicare reimbursements over time. In general, the number of breast reconstructions increased over the study period, with the greatest increase in free flap breast reconstruction (+55.5%) and the greatest decrease in TRAM reconstruction (−36.9%). On average, the Medicare payment amount per service was about 20% of the submitted charge. For example, reconstruction with latissimus flap charge in 2017 was $6,588 and payment amount was $1,358, resulting in a 79.4% reduction. Despite inflation and overall increases in healthcare costs, reimbursements in breast reconstruction have had little or no increase over time. The highest rate of change was Current Procedural Terminology 19366 (breast reconstruction with other technique), which increased from $957 in 2012 to $1,136 in 2017, for an +18% rate of change. Over the study interval, implant-based reconstruction increased around 12%, whereas latissimus and free flap reconstruction decreased around 2% over the same time interval. CONCLUSION: Our study identifies and quantifies wide variations in reimbursement for breast reconstruction procedures. Over the study period, reimbursement for implant-based reconstruction increased while autologous reconstruction decreased. Variations in reimbursement may preclude some surgeons from offering certain reconstructive options to a subset of patients. Addressing these potential care disparities in a growing patient population has major implications in quality of care for a large subset of women recovering from breast cancer. It is important for surgeons to understand these trends and to communicate with policy makers toward developing sustainable reimbursement models.