Endoscopy-assisted muscle-sparing Latissimus Dorsi muscle flap harvesting for partial breast reconstruction

Abstract

Background: Using the Latissimus dorsi (LD) muscle flap is one of the popular surgical technique for breast reconstruction. However, usually, long postoperative scar was remained on donor site which does not have disease. The authors applied the endoscopy-assisted surgery to harvest the LD muscle flap for breast reconstruction. Methods: From July 2018 to July 2019, five consecutive patients with breast cancer underwent partial mastectomy with endoscopy-assisted LD muscle flap reconstruction. The clinic-pathologic factors were analyzed and the cosmetic outcomes were assessed with breast shape, scarring of breast and back. A 4-6 cm of lateral incision (donor site scar) was designed and LD muscle was harvested under endoscopic surgery without gas inflation. And the harvested LD muscle was inserted for partial breast reconstruction after the cancer surgery was done. Results: Mean operative time was 116.4 min (range, 92-134) and there was no major postoperative complication. The satisfactory degree of cosmetic outcomes were shown better in patient's survey than that of surgeon's. Conclusions: The endoscopy-assisted LD muscle flap harvesting would be useful technique to eliminate a large donor site incision in partial breast reconstruction.

Combined Endoscopy-Assisted Muscle-Sparing Latissimus Dorsi Flap Harvesting with Lipofilling Enhancement as a New Volume Replacement Technique in Breast Reconstruction

“…Our technique was different compared with the technique described by Lee et al [ 17 ], as we used a breast retractor with an attached 10 mm camera. It offered the advantage of better camera handling through the narrow space and freed one hand of the assistant.…”

“…Limited space and difficult angles were the main obstacles hindering endoscopic breast surgery [14,15]. However, endoscopic surgery for harvesting the LD flap has been reported more frequently because securing space is easier in the LD cavity than in the breast [16][17][18]. Endoscopy-assisted LD flap harvest may eliminate the problem of scarring of the donor site, but the small size of the LD flap requires augmentation to be useful in proper reconstruction of the breast.…”

Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients

“…Yet the implant always makes the breast feel stiff and the transition area between breast and chest wall looks unnatural, especially when the implant size is large to fit the large contralateral breast. As for the autologous tissue flap, mastectomy with LD flap transfer could only be beneficial for women with small-to-medium-sized breasts with upper outer quadrant breast cancer who desire breast conservation surgery [ 3 , 4 , 9 ], because the provided volume is insufficient to achieve the total breast reconstruction.…”

“…The conventional LD flap harvest requires a long incision that often results in an apparent scar over the back which becomes one of the main concerns of the patients [ 9 ]. The endoscopy-assisted muscle harvest technique is becoming popular in breast reconstruction because it obviates the need for an obvious posterior donor site scar by using a small lateral extension of the mastectomy incision.…”

A Retrospective Study of Latissimus Dorsi Flap in Immediate Breast Reconstruction

“…Second, there are two incisions in the skin for these three methods. As the development of modern technologies, the latissimus dorsi muscle flaps can also be harvested by modern techniques such as endoscopic and robotic procedure with little scar and good appearance (16)(17)(18)(19). But these two modern techniques are not widely used especially in developing countries, and there is a long learning curve.…”