Immediate breast reconstruction with a myocutaneous latissimus dorsi flap and implant following skin-sparing salvage mastectomy after irradiation as part of breast-conserving therapy

Huizum, Martine A. van; Hage, J. Joris; Rutgers, Emiel J. T.; Hoornweg, Marije J.

doi:10.1016/j.bjps.2016.01.018

Cited by 15 publications

(9 citation statements)

References 13 publications

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“…Its benefits serving this role have been studied extensively and demonstrated to decrease the rates of complication compared with purely prosthetic-based reconstruction. 10,30,31 The introduction of well-perfused, pliable soft tissues may mitigate the adverse effects of radiation, improving wound healing and decreasing risks of capsular contracture. 10,30 Overall, patients benefit from salvage rates as high as nearly 95% 31 in addition to the potential for very good to excellent aesthetic results.…”

Section: Discussionmentioning

confidence: 99%

Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm

Kokosis

Khavanin

Nahabedian³

2019

Plastic and Reconstructive Surgery - Global Open

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Purpose:The latissimus dorsi (LD) flap is an ideal flap for salvage following failed primary breast reconstruction in the setting of radiation therapy. This study will review outcomes following secondary reconstruction with the LD flap with or without a tissue expander (TE) or implant (I).Methods:The following 4 cohorts were included: 1-stage LD only in 28 patients (48.3%), 1-stage LD + I in 7 patients (12.1%), 2-stage LD + TE/I in 8 patients (13.8%), and 3-stage LD + TE + I in 15 patients (25.9%).Results:The average age across all patients was 53.2 years. Complications did not differ significantly across the 4 cohorts. Complications included partial flap necrosis, wound dehiscence, seroma, and infection occurring in 4 of 28 patients of 1-stage LD alone, 2 of 7 (28.6%) patients of 1-stage LD + I, 5 of 8 (52.5%) patients of 2-stage LD + TE/I, and 4 of 15 (26.7%) patients of 3-stage LD + TE + I (P = 0.055). Reoperation rates were 10.7%, 14.3%, 25%, and 0% across the 4 cohorts, respectively (P = 0.295). The LD only cohort had a 14.3% surgical revision rate, compared with 42.9% in the 1-stage + I, 50% in the 2-stage + TE/I, and 33.3% in the 3-stage LD + TE + I (P = 0.135). The rate of contralateral symmetry procedures was 10.7%, 0%, 25%, and 6.7%, across the 4 cohorts, respectively (P = 0.410).Conclusion:Secondary breast reconstruction with the LD flap in 1, 2, or 3 stages has demonstrated success. A decision-making algorithm is provided.

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Section: Discussionmentioning

confidence: 99%

Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm

Kokosis

Khavanin

Nahabedian³

2019

Plastic and Reconstructive Surgery - Global Open

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“…The surgical complication rate after primary mastectomy (varying from seroma, wound infection and wound dehiscence) varies between 10 and 30% in recent studies [20,21]. The incidence of seroma and other short-term complications in patients with salvage mastectomy after previous irradiation as part of a primary breast-conserving treatment varies from 17 to 27% [22][23][24]. One would expect that repeat breast-conserving surgery in a previously irradiated area could yield wound healing problems, leading to delay of the re-irradiation, a worse cosmetic outcome or ultimately the need for a salvage mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

Walstra

Schipper

Riet

et al. 2021

Breast Cancer Res Treat

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Background In line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumour recurrence (IBTR) in selected patients. The conditions for the feasibility of a repeat BCT vary widely in literature. In clinical practice, many physicians have ongoing concerns about the oncological safety and possible toxicity of repeat BCT. Aim To investigate the attitude of Dutch breast surgeons and radiation oncologists towards repeat BCT and to report on their experiences with, objections against and perceived requirements to consider a repeat BCT in case of IBTR. Patients and methods An online survey consisting of a maximum of 26 open and multiple-choice questions about repeat BCT for IBTR was distributed amongst Dutch breast surgeons and radiation oncologists. Results Forty-nine surgeons representing 49% of Dutch hospitals and 20 radiation oncologists representing 70% of Dutch radiation oncology centres responded. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. The most important factors to consider a repeat BCT for both groups were the patient’s preference to preserve the breast and surgical feasibility of a second lumpectomy. Arguments against a repeat BCT were based on the perceived unacceptable toxicity and cosmesis of a second course of radiotherapy. The technique of preference for re-irradiation would be partial breast irradiation (PBI) according to all radiation oncologists. Differentiating between new primary tumours (NPT) and true recurrences (TR) was reported to be done by 57.1% of breast surgeons and 60% of radiation oncologists. The most important reason to differentiate between NPT and TR was to establish prognosis and to consider whether a repeat BCT would be feasible. Conclusion An increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient’s preference and with partial breast re-irradiation.

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“…In spite of these statistically higher rate of poor prognostic factors in PM + MLDF group, no differences were seen between the groups in terms of 5-year local recurrence (2% and 3%) and overall survival rates (97% in both groups). Prosthetic-based breast reconstruction was associated with increased major breast complications up to 49% [44][45][46][47][48][49]. It is expensive and results in delays for adjuvant systemic treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

et al. 2020

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Purpose: The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. Patients and methods: The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively.

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Immediate breast reconstruction with a myocutaneous latissimus dorsi flap and implant following skin-sparing salvage mastectomy after irradiation as part of breast-conserving therapy

Cited by 15 publications

References 13 publications

Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm

Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm

Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

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