Endoscopically harvested latissimus dorsi: a scarless technique in immediate partial breast reconstruction

Minimally invasive harvest of the latissimus dorsi flap for breast reconstruction: A systematic review

“…40,45 Several authors harvested 15%-30% more muscle volume than necessary during dissection foreseeing muscular atrophy, sometimes even recruiting the adjacent fat or using fat grafting. 4,[19][20][21][22]31,51,52 In this review, the short follow-up and lack of blinding while assessing the cosmesis of the reconstruction may overestimate the long-term aesthetic outcomes of reconstructed breasts with a pure muscle LDF. In fact, the average volume loss at 6-8 months after surgery has been reported to be 54.5%, with a further volume loss at 18 months.…”

“…The indications for an EALDF were breast reconstruction after lumpectomy (n = 46), 10,20,23 quadrantectomy (n = 58), 18,20,34,35 partial (n = 44) 2,4,19,31 or total mastectomy (n = 325), 11,17,22,24,26,[36][37][38] and Poland syndrome (n = 22) (Data S2). 25,28,29,33 42 patients had neoadjuvant chemotherapy (range, 8.3%-100%), 2,10,20,22,34 one patient had neoadjuvant radiotherapy (3%), 10 325 received adjuvant radiotherapy (range, 6.4%-100%), 2,10,11,[17][18][19][20]22,26,31,35,36 and 20 had adjuvant chemotherapy (range, 40%-90.3%). 2,17,26,31,36 Before reconstruction with RALDFs, robotic-assisted mastectomies were performed in four studies.…”

“…17,23,25,33 Fat grafting was performed in one study. 25 Visualisation of the surgical field was achieved with right angle suspension hooks, 38 25-mm optical retractors, 20 retractor and traction stitches, 18,24 CO 2 gas insufflation, 4,11,23,28,31,34,37 customised retractors, 25 or non-specific endo-retractors (Data S3). 2,17,19,22,26,33,36 The length of incisions for endoscopy ports ranged from 1.8 to 6 cm.…”

“…The total surgical time was 201.05 min in patients with Poland syndrome, 25,28 222.18 min for patients who had total mastectomy, 11,22,26,37 and 226 min who had a partial mastectomy (Figure 2). 2,19,20,34 The average LDF harvest time was 84.04 min (range, 25-240) (Figure 3) (Data S4). 2,4,11,17,20,23,25,26,36,37 When compared to the OT, Chang et al found an increased total operative time for EALDF (368 � 61 vs. 257 � 59, p = 0.0006) 31 while Kim et al did not find a significance difference between groups (p = 0.354) (Data S5).…”

“…Primary reconstruction was the most common type of reconstruction. 4,10,11,18,20,22,23,25,31,34,38 A delayed single-stage reconstruction was reported in three studies. 26,35,37 As part of a 2-stage reconstruction, in five studies the EALDF was harvested during tissue expander (TE)-to-implant exchange 17,24,29,33,36 ; and in two studies during immediate TE placement.…”