Pedicled descending branch latissimus dorsi mini‐flap in repairing partial mastectomy defect: Shoulder functional and esthetic outcomes

Zhou, Lei; Wang, Yan; Cai, Ruizhao; Huang, Junhao; Li, Xing; Xie, Zhigang; Wang, Jin; Sun, Yun; Chang, Edward I.; Tang, Jun

doi:10.1002/jso.25524

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…Another study analyzing 174 patients using the Q-DASH scores showed that LDMF has a negative impact on shoulder function [ 12 ]. Although Zhou et al [ 13 ] showed no significant differences in muscle strength, shoulder range of motion, disabilities of the arm, shoulder, and hand scores between the LDMF and conventional BCS groups, the varied results may be due to the small number of patients analyzed in this study. The poor physical well-being experienced by patients after LDMF compared to that after TM in previous studies suggests that muscle damage and associated dysfunction could be a weakness of LDMF.…”

Section: Discussionmentioning

confidence: 57%

Comparison of Quality of Life and Cosmetic Outcome of Latissimus Dorsi Mini-Flap With Breast Conservation Surgery Without Reconstruction

et al. 2023

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Purpose Latissimus dorsi mini-flap (LDMF) reconstruction after breast-conserving surgery (BCS) is a useful volume replacement technique when a large tumor is located in the upper or outer portion of the breast. However, few studies have reported the impact of LDMF on patients’ quality of life (QoL) and cosmesis compared with conventional BCS. Methods We identified patients who underwent BCS with or without LDMF between 2010 and 2020 at a single center. At least 1 year after surgery, we prospectively administered the BREAST-Q to assess QoL and obtained the patients’ breast photographs. The cosmetic outcome was assessed using four panels composed of physicians and the BCCT.core software. Results A total of 120 patients were enrolled, of whom 62 and 58 underwent LDMF or BCS only, respectively. The LDMF group had significantly larger tumors, shorter nipple-to-tumor distances in preoperative examinations, and larger resected breast volumes than did the BCS-only group ( p < 0.001). The questionnaires revealed that QoL was poorer in the LDMF group, particularly in terms of the physical well-being score (40.9 vs. 20.1, p < 0.001). Notably, the level of patients’ cosmetic satisfaction with their breasts was comparable, and the cosmetic evaluation was assessed by panels and the BCCT.core software showed no differences between the groups. Conclusion Our results showed that cosmetic outcomes of performing LDMF are comparable to those of BCS alone while having the advantage of resecting larger volumes of breast tissue. Therefore, for those who strongly wish to preserve the cosmesis of their breasts, LDMF can be considered a favorable surgical option after the patient is oriented toward the potential for physical dysfunction after surgery.

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Section: Discussionmentioning

confidence: 57%

Comparison of Quality of Life and Cosmetic Outcome of Latissimus Dorsi Mini-Flap With Breast Conservation Surgery Without Reconstruction

et al. 2023

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“…Besides mastectomy and BCS, we noticed that 17 patients received breast reconstruction at the same time. Pedicled descending branch latissimus dorsi mini flap is used in BCS to guarantee a satisfactory cosmetic result, in the situation of extensively lesions, hematoma or far distance from lesion to Mammotome biopsy spot, that has been reported by our department previously (20,21). For those widespread diseases and diffuse microcalcifications, the nipple-areola complex and skin spared mastectomy combined with breast implants might be an appropriate alternative way.…”

Section: Discussionmentioning

confidence: 99%

Does Mammotome biopsy affect surgery option and margin status of breast conserving surgery in breast cancer?

Kong¹,

Lyu²,

Wang³

et al. 2021

Gland Surg

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Background: The Mammotome, an image-guided, usually ultrasound-guided vacuum-assisted breast biopsy (US-VABB) system, has been widely used in the early diagnosis of breast disease and the complete excision of benign lesions. However, in some malignant lesions underestimated by U.S., whether Mammotome biopsy would affect the surgery option, especially the margin status in breast-conserving surgery (BCS), has never been studied.Methods: Between 2015 and 2019, 198 patients with 200 lesions who have been diagnosed with breast cancer by Mammotome elsewhere received surgery by pathological confirmation in our center. The clinicopathological characteristics, surgery options, therapies, and the details of the specimen, such as margin status of BCS, tumor residual after VABB, and hematoma were reviewed.Results: Among 200 lesions, 90% were evaluated below US-BIRADS 4b before Mammotome biopsy and 94.5% with a tumor size ≤3 cm. 131 patients received mastectomy (66.2%) and 67 received BCS (33.8%).Hematoma and tumor residual were observed in 37.5% and 71.5% of all lesions, respectively. There is a higher incidence of hematoma in the mastectomy group than in the BCS group (44.4% vs. 23.9%, P=0.005).In BCS group, the positive margin was found in 7 patients at first examination including four focals with reexcision, two extensive with mastectomy and one focal but refusing further surgery. The ultimate success rate of BCS was 95.5%. Margin positivity correlated with tumor residual (P=0.044) but not with hematoma.Conclusions: Mammotome biopsy might lead to hematoma and tumor residual; however, it is not the determinant factor for a surgery option, and BCS is feasible through a complete excision of tumor residual to acquire negative margin.

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“…In an observational study, Zhou et al compared shoulder morbidity in two groups: latissimus dorsi (LD) mini-flap vs. conventional BCS (depending on the need for replacement of volume) and found the LD mini-flap an excellent additional technique to conventional BCS according to shoulder morbidity ( 40 ). With a follow-up of 1 year, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used, and an objective evaluation of range of motion (ROM) and muscle strength was made.…”

Section: Key Contents and Findingsmentioning

confidence: 99%

Shoulder function following oncoplastic breast conserving surgery—a narrative review

Lautrup,

Rindom,

Hauerslev

2024

Gland Surg

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Background and Objective The high prevalence of breast cancer survivors makes it very relevant to investigate late morbidity following the treatment. Oncoplastic breast conserving surgery (OPS) has gained great popularity over the past years, and evidence-based knowledge suggest better prognosis for treatment with breast conserving surgery (BCS) compared to mastectomy. The aim was to investigate if OPS causes late effects on an acceptable level compared to what we know about breast surgery causing late effects. Methods Using the Medical Subject Headings (MeSH) terms “Breast Neoplasms”, “shoulder”, “oncoplast*”, and “reconstruct*”, the databases PubMed, Embase, and Scopus were searched on the 6 th of June 2023. The literature search was managed in Covidence. We focused on studies describing late effects especially shoulder function including restrictions in mobility, reduced strength, as well as functional impairment. Key Content and Findings Nine studies fulfilled the inclusion criteria. Different kinds of oncoplastic procedures were described—most of them described volume replacement procedures. The knowledge of shoulder morbidity following OPS is limited. The heterogeneity in the selected studies was broad. Some of the studies were small and there was a considerable variation in follow-up time. They described shoulder function based on several different evaluation methods [range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH), Quick-DASH (Q-DASH), Shoulder Pain and Disability Index (SPADI), health-related quality of life (HRQoL), and non-validated subjective questionnaires]. All studies found acceptable levels of shoulder morbidity. Conclusions The requisite knowledge of late effects following OPS is still not available for unambiguous recommendations. This narrative review has elucidated the knowledge and has reached a conclusion based on review of the existing literature of this item. We found that the risk of decreased shoulder function caused by OPS—volume displacement as well as volume replacement—does not exceed the risk of shoulder problems seen after BCS and mastectomy with or without immediate reconstruction. Therefore, OPS can be considered if conventional BCS is not possible. But the knowledge of shoulder function after OPS is limited, and studies comparing shoulder function after OPS, BCS and mastectomy with or without immediate reconstruction are warranted.

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Pedicled descending branch latissimus dorsi mini‐flap in repairing partial mastectomy defect: Shoulder functional and esthetic outcomes

Cited by 8 publications

References 26 publications

Comparison of Quality of Life and Cosmetic Outcome of Latissimus Dorsi Mini-Flap With Breast Conservation Surgery Without Reconstruction

Comparison of Quality of Life and Cosmetic Outcome of Latissimus Dorsi Mini-Flap With Breast Conservation Surgery Without Reconstruction

Does Mammotome biopsy affect surgery option and margin status of breast conserving surgery in breast cancer?

Shoulder function following oncoplastic breast conserving surgery—a narrative review

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