Secondary breast reconstruction in small to medium-sized irradiated breasts: could Fat-Augmented LD (FALD) flap be a reliable alternative?

Abstract

Background: Secondary breast reconstruction (BR) is recognized as a challenging procedure, particularly when radiotherapy (RT) has previously been performed. The aim of this study was to compare operative data and aesthetic outcomes between secondary irradiated and immediate BR using the fat-augmented latissimus dorsi (FALD) flap. Methods: The authors conducted a prospective clinical study between September of 2020 and September of 2021. Patients were divided into two groups: group A included secondary BR using the FALD flap in previously irradiated breasts, and group B included immediate BR with the FALD flap. Demographics and surgical data were compared, and an aesthetic analysis was performed. Chi-square and t tests were performed for categorical and continuous variables, respectively. Results: Twenty cases of FALD flap-based BR for each group were included. The two groups were found to be homogeneous for the demographic variables. The difference in mean operative time (263.1 minutes versus 265.1 minutes; P = 0.467) and complications (P = 0.633) between the two groups were not significant. There was statistically significant difference in term of immediate fat grafting volume in favor of group A (218.2 cc versus 133.0 cc; P < 0.0001). Regarding aesthetic outcomes, the mean global score evaluation showed no statistically significant differences between groups (17.86 versus 18.21; P = 0.209). Conclusions:The authors' study states that the FALD flap can be considered a reliable procedure for secondary reconstruction in previously irradiated breasts, although it is not indicated for patients with larger breasts. This surgical technique allowed us to achieve a totally autologous BR with good aesthetic results and low complication rates, even in secondary irradiated cases. (Plast.

BIA-ALCL and BIA-SCC: Updates on Clinical Features and Genetic Mutations for Latest Recommendations

“…However, since there are no epithelial cells in the periprosthetic tissue, these would come from either external contamination or the galactophore duct epithelial cells that were resected during the reconstruction or implantation procedures. Because periareolar access has a larger chance of causing a galactophore recision than inframammary fold access, it is imperative that we exercise caution when manipulating the implant and avoid causing friction with the skin surface [59][60][61][62]. Despite being two distinct tumor types with different behaviors, BIA-ALCL and BIA-SCC share similar signs and symptoms of presentation, including late seroma, breast tenderness, and swelling, which require prompt investigation with an ultrasound exam and consequential cytological examination if the presence of periprosthetic fluid is detected.…”

High cure rate and satisfaction in patients with periductal mastitis via the latissimus dorsi myocutaneous flap technique: a retrospective study

“…In addition to stable survival, it has considerable thickness, which can successfully repair breast defects and replace the role of the pectoralis major muscle in providing adequate blood nutrition for adjacent tissue structures. In this regard, the LDMF has also been used to repair previously irradiated breasts ( 18 ), and fat-augmented latissimus dorsi (FALD) autologous reconstruction is superior to latissimus dorsi-plus-implant reconstruction for those women subjected to irradiation ( 19 , 20 ). Since its advantages in breast reconstruction were first described by Tansini in 1906 ( 21 ), LDMF has been widely used in breast reconstruction, achieving effective individualized treatment.…”

Shoulder Function Assessment After Fald Flap Breast Reconstruction: Comparing Ultrasound Results and Patients’ Self Perception

“…Each surgical procedure was performed by a single surgeon (B.L.) using the same surgical technique 22,23 . Pre-operatively (t0), each patient was asked to perform a shoulder ultrasound examination, to measure the acromio-humeral interval (AHI), and to fill in the DASH questionnaire so to assess the subjective baseline conditions.…”