The purpose of this study was to measure, both objectively and subjectively, the sensitivity of breasts reconstructed with the autologous latissimus dorsi flap and to compare these results with those of other reconstruction techniques, especially the transverse rectus abdominis myocutaneous flap. The study population included 50 patients with autologous latissimus dorsi flap breast reconstruction; these patients had an average age of 51 years and an average follow-up of 27 months. Patients answered a seven-item questionnaire that attempted to define the sensitivity of the reconstructed and opposite breasts. This sensitivity was then measured objectively using standard techniques for heat, cold, and tactile sensations. After statistical analysis, these results were compared with those published for other reconstruction techniques. Overall results were comparable or superior to those published for other techniques for autologous breast reconstruction. A total of 56 percent of patients had fine or very fine sensitivity, but 70 percent deemed this sensitivity to be less than that of the opposite breast. A total of 94 percent of patients perceived the reconstructed breast as integral to their body image. The superior medial part of the breast had the greatest sensitivity, both objectively and subjectively. Autologous latissimus dorsi breast reconstruction, a good technique with excellent aesthetic results, affords satisfactory sensitivity. This is yet another advantage of the technique.
A technique of immediate breast reconstruction, combining skin sparing mastectomy and autologous latissimus breast reconstruction, is presented. In this study, 50 patients underwent this procedure between May 1993 and May 1997. The most frequent indication (62%) was ductal carcinoma in situ (multifocal, high grade or larger than 3 cm). In 38% of cases, the patients had a contraindication to the TRAM flap; in the other cases (62%) the patients preferred the dorsal donor site to the abdominal site. Reduction of the contralateral breast was done in 20% of cases of unilateral reconstruction. The aesthetic results, evaluated by two others surgeons, were rated as very good in 88% of cases, good in 8% and poor in 4%. Study of patient satisfaction showed 84% of patients to be pleased, 12% satisfied and 4% poorly satisfied. Dorsal sequelae were rated as slight in 96% of cases, intermediate in 4% and marked in none. The main disadvantage was dorsal seroma which occurred in 62% of cases but was easily managed by repeated aspiration. No patient developed a local recurrence or distant metastases. This technique represents a significant advance in breast reconstruction, giving a breast of natural shape and consistency with no transverse scar or patch effect due to the flap.
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