Breast Reconstruction in Obese Patients: The Fat Grafted Latissimus versus Abdominal Free Tissue Transfer

Abstract

Background: Immediate fat grafting to the pedicled myocutaneous latissimus dorsi (LD) flap has recently gained in popularity as a means to supplement volume for breast reconstruction. The aim of this study is to compare complication rates of the immediately fat-grafted LD to free tissue transfer in the obese population. Methods: In this retrospective cohort, 82 patients (149 breasts) from 2015 to 2019 were included. Patients underwent either unilateral or bilateral breast reconstruction with either LD with immediate fat grafting or abdominal-based free tissue transfer. Included patients had a body mass index ≥ 30 kg/m2 at the time of surgery. Complication data were recorded as minor, major, and medical complications. Procedure characteristics and postoperative data were also studied. Results: Minor complication rates between the LD with immediate fat grafting and free tissue transfer cases were similar (26.9% versus 26%, respectively). The free tissue transfer group had a significantly higher rate of major complications (20.3% versus 3.8%; P = 0.048) and medical complications (10.6% versus zero). Finally, the LD with immediate fat grafting group had significantly shorter operating room times, hospital length of stay, and fewer donor-site revisions. Conclusions: LD with immediate fat grafting offers the benefit of a totally autologous reconstruction without the risks of abdominal-based microvascular free tissue transfer or an implant. Favorable complication rates, shorter operative times, and shorter hospital length of stay make this reconstructive option a safe alternative to free tissue transfer in the obese population.

A Recurrent Giant Phyllodes Tumor with Review of Literatures

“…Its advantage include minimal functional morbidity as result of harvesting the muscle, low risk of flap necrosis (1%) and as result of unsevred neurovascular supply reduced donor-site morbidity in addition to its superiority in high-risk patients who may be unsuitable for TRAM or DIEM flaps. Its commonest complication are donor site seroma, shoulder weakness, donor -site pain and development of capsular contraction in some patients with implants [29][30][31][32]. In our case we did autologous latissimus dorsi flap rotational flap and the donor-site was grafted with split thickness skin graft the patients post-operative course was uneventful.…”

Breast reconstruction with latissimus dorsi flap: a comprehensive review and case series

“…Interestingly, when compared to other reconstructive alternatives, previous studies have demonstrated a higher rate of additional surgeries using LDF compared to abdominal-based free flaps following unilateral, delayed breast reconstruction after postmastectomy radiotherapy (92.1% versus 67.3%; P<0.001) ( 51 ). Other series comparing the rate of revision procedures between LIFT and abdominal free tissue transfer have demonstrated comparable or similar outcomes between groups ( 52 ).…”