Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap

Szychta, Paweł; Butterworth, Mark; Dixon, Mike J.; Kulkarni, Deepak; Stewart, Kenneth J.; Raine, Cameron

doi:10.1016/j.breast.2013.01.001

Cited by 39 publications

(30 citation statements)

References 26 publications

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“…After radiation therapy, because the latissimus dorsi muscle is denervated and radiated, the reconstructed breast displays shrinkage. A previous study reported that denervated flaps atrophy, but shrinkage has also been observed in innervated flaps without a statistically significant difference in the conventional latissimus dorsi myocutaneous flap [18]. As endoscopic partial reconstruction uses the latissimus dorsi muscle only, we can expect more shrinkage after denervation.…”

Section: Discussionmentioning

confidence: 93%

Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

et al. 2014

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BackgroundCurrently, breast conservation therapy is commonly performed for the treatment of early breast cancer. Depending on the volume excised, patients may require volume replacement, even in cases of partial mastectomy. The use of the latissimus dorsi muscle is the standard method, but this procedure leaves an unfavorable scar on the donor site. We used an endoscope for latissimus dorsi harvesting to minimize the incision, thus reducing postoperative scars.MethodsTen patients who underwent partial mastectomy and immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest were reviewed retrospectively. The total operation time, hospital stay, and complications were reviewed. Postoperative scarring, overall shape of the reconstructed breast, and donor site deformity were assessed using a 10-point scale.ResultsIn the mean follow-up of 11 weeks, no tumor recurrence was reported. The mean operation time was 294.5 (±38.2) minutes. The postoperative hospital stay was 11.4 days. Donor site seroma was reported in four cases and managed by office aspiration and compressive dressing. Postoperative scarring, donor site deformity, and the overall shape of the neobreast were acceptable, scoring above 7.ConclusionsReplacement of 20% to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap by using endoscopic harvesting is a good alternative reconstruction technique after partial mastectomy. Short incision benefits from a very acceptable postoperative scar, less pain, and early upper extremity movement.

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Section: Discussionmentioning

confidence: 93%

Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

et al. 2014

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“…The employment of regression and other sophisticated statistical methods with a larger cohort will help to mitigate these and other potential confounders that limit the current analysis. Furthermore, although the scoring scale used in this study achieved satisfactory inter-rater reliability and sensitivity to discern differences in symmetry, longer photographic follow-up, additional lateral or oblique-lateral views, and computer assisted analysis of photographic data in future studies will enable precise topographic mapping and the identification of irregularities in symmetry and a number of other cosmetic parameters [9]. …”

Section: Discussionmentioning

confidence: 99%

Tabbed Tissue Expanders Improve Breast Symmetry Scores in Breast Reconstruction

et al. 2014

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BackgroundAchieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders.MethodsA chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers.ResultsOf the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort (2.82/4±0.86 vs. 2.55/4±0.92, P=0.034).ConclusionsThe use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.

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“…1,2 On the other hand, pain and unwanted breast animation are two well recognised drawbacks of the LD reconstruction which have been improved by surgical denervation. 2,3 Although this study did not show any significant difference between the two groups in terms of the adverse effects mentioned, authors such as Halperin et al have described the need for performing delayed nerve division in up to 41% of their patients to treat active muscle twitching and discomfort. In this group of patients, 5% had residual twitching which was thought to be due to the division of a branch, rather than the main trunk of the thoracodorsal nerve.…”

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confidence: 81%

Thoracodorsal nerve division in latissimus dorsi breast reconstruction to avoid unwanted breast animation: A safe and simple technique to ensure division of all branches

Hwang

Sterne

2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap

Cited by 39 publications

References 26 publications

Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

Tabbed Tissue Expanders Improve Breast Symmetry Scores in Breast Reconstruction

Thoracodorsal nerve division in latissimus dorsi breast reconstruction to avoid unwanted breast animation: A safe and simple technique to ensure division of all branches

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