Latissimus dorsi breast reconstruction with or without implants: A comparison between outcome and patient satisfaction

Leuzzi, Sara; Stivala, Alessio; Shaff, J.B.; Maroccia, A.; Rausky, J.; Revol, M.; Bertrand, B.; Cristofari, S.

doi:10.1016/j.bjps.2018.10.003

Cited by 23 publications

(57 citation statements)

References 36 publications

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“…There are alternative donor sites for both pedicle and free flap. Latissimus dorsal pedicle flap is an option, but this procedure is often combined with an implant-based reconstruction or a breast conserving therapy to fill the defect breast volume [ 144 ]. The latter is more applicable to BRCA negative women since they more often have breast conserving therapy.…”

Section: Surgical Procedures Associated With Female With Brca Mutationmentioning

confidence: 99%

Management of patients with BRCA mutation from the point of view of a breast surgeon

Riis

2021

Annals of Medicine &Amp; Surgery

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Germ-line mutation in BRCA (BReast CAncer gene) 1 or BRCA2 are found in 3–4% of all women with breast cancer. These patients have a significant increased risk of breast and ovarian cancer. They are often younger when diagnosed with the mutation, and the possible breast cancer they get is often aggressive with inferior outcome. There are risk reducing strategies, and the most powerful strategy is risk reducing surgery, both risk reducing bilateral mastectomy (RRM) and risk reducing bilateral salpino-oophorectomy (PBSO). This review is meant to address breast surgery in patients with germline BRCA mutation. The guidelines and techniques applied is under continuous change and it is important for the clinicians to be well informed to provide the patient with the information needed for them to make an informed decision on what risk strategy to choose.

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Section: Surgical Procedures Associated With Female With Brca Mutationmentioning

confidence: 99%

Management of patients with BRCA mutation from the point of view of a breast surgeon

Riis

2021

Annals of Medicine &Amp; Surgery

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“…The latissimus dorsi (LD) myocutaneous flap has been previously described by others as a definitive autologous reconstructive option in some patients with lower complication rates than abdominal free tissue transfer, especially in patients who are obese. 9 , 19 , 20 The major criticism of this flap is the lack of sufficient volume to provide a definitive reconstruction, which is often addressed with both immediate 21 – 24 and or delayed fat grafting, 25 implant placement 26 – 28 or harvesting an extended flap with additional soft tissue from the donor site. 29 , 30 The muscle-sparing latissimus dorsi (MSLD) flap has also been described as an alternative to the traditional LD flap for total or partial breast reconstruction, with the advantages of ease of dissection (when compared with a perforator flap), preservation of 75% of the muscle with no obvious postoperative functional sequelae with regard to strength and range of motion, significantly decreased incidence of donor site seroma, less postoperative pain and quicker recovery, preservation of the axillary silhouette with a minimal risk of contour deformities in the back.…”

Section: Introductionmentioning

confidence: 99%

Muscle-sparing Latissimus Dorsi: A Safe Option for Postmastectomy Reconstruction in Extremely Obese Patients

Schwartz

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Postmastectomy reconstruction in obese patients has a significant risk of complications and poor outcomes after implant-based and autologous methods. Here we present 22 consecutive patients with Class III obesity [body mass index (BMI) > 40 kg/m2] who underwent reconstruction with a muscle-sparing latissimus dorsi (MSLD) flap. Methods: A chart review of a single surgeon experience with 22 consecutive patients with Class III obesity who underwent postmastectomy reconstruction with an MSLD flap was performed. Demographics, operative details, outcomes, and complications were evaluated. Results: Twenty-two patients underwent 29 mastectomy and MSLD reconstructions. There were no flap failures. The average BMI was 47.2 kg/m2, including 12 patients with BMI > 50 kg/m2. Seven breasts demonstrated partial nipple and or mastectomy flap necrosis. There was 1 (3.4%) donor site dehiscence that healed with outpatient wound care and 1 (3.4%) seroma that required multiple aspirations in the office. The average operative times were 178 and 420 minutes for unilateral and bilateral mastectomy and immediate reconstructions, respectively. The average hospital length of stay was 0.56 and 1.3 days for unilateral and bilateral surgeries, respectively. Conclusions: These results demonstrate the utility of the MSLD flap in reconstructing the very obese. Operative times and lengths of stay compare favorably with conventional latissimus dorsi flap and abdominal-based microvascular free tissue transfer reconstructions. While our complication rates were higher than historically seen for patients with normal BMIs, there were no instances of flap failure, making this a viable reconstructive option for these very high-risk patients.

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“…Despite not having a consensus on whether implant- or autologous-based reconstruction is better for patients, autologous-based reconstruction is currently recognized as the best option by providing the patient with a more natural look and feel [ 8 ]. When it comes to selecting the type of reconstruction a patient should receive, race, region, and insurance should not be determining factors.…”

Section: Discussionmentioning

confidence: 99%

“…As breast reconstruction rates increase [ 6 ], and with laws that make the procedure more widely available to the US population [ 7 ], new procedures have been developed and have proven to be as good, or better, than previous procedures. Breast reconstruction techniques currently available can be divided into autologous tissue-based or implant-based techniques [ 8 ]. Implant-based reconstruction is the most common type of reconstruction; however, women who receive autologous reconstruction have shown a higher rate of satisfaction [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Disparities in Access to Autologous Breast Reconstruction

et al. 2020

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Background and objectives: This study aimed to determine if age, race, region, insurance, and comorbidities affect the type of breast reconstruction that patients receive. Materials and methods: This analysis used the Florida Inpatient Discharge Dataset from 1 January 2013 to 30 September 2017, which contains deidentified patient-level administrative data from all acute care hospitals in the state of Florida. We included female patients, diagnosed with breast cancer, who underwent mastectomy and a subsequent breast reconstruction. We performed an χ2 test and logistic regression in this analysis. Results: On the multivariable analysis, we found that age, race, patient region, insurance payer, and Elixhauser score were all variables that significantly affected the type of reconstruction that patients received. Our results show that African American (odds ratio (OR): 0.68, 95%CI: 0.58–0.78, p < 0.001) and Hispanic or Latino (OR: 0.82, 95%CI: 0.72–0.93, p = 0.003) patients have significantly lower odds of receiving implant reconstruction when compared to white patients. Patients with Medicare (OR: 1.57, 95%CI: 1.33–1.86, p < 0.001) had significantly higher odds and patients with Medicaid (OR: 0.61, 95%CI: 0.51–0.74, p < 0.001) had significantly lower odds of getting autologous reconstruction when compared to patients with commercial insurance. Conclusions: Our study demonstrated that, in the state of Florida over the past years, variables, such as race, region, insurance, and comorbidities, play an important role in choosing the reconstruction modality. More efforts are needed to eradicate disparities and give all patients, despite their race, insurance payer, or region, equal access to health care.

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Latissimus dorsi breast reconstruction with or without implants: A comparison between outcome and patient satisfaction

Cited by 23 publications

References 36 publications

Management of patients with BRCA mutation from the point of view of a breast surgeon

Management of patients with BRCA mutation from the point of view of a breast surgeon

Muscle-sparing Latissimus Dorsi: A Safe Option for Postmastectomy Reconstruction in Extremely Obese Patients

Disparities in Access to Autologous Breast Reconstruction

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