Single-Stage Breast Reconstruction with the Anterior Approach Latissimus Dorsi Flap and Permanent Implants

Bittar, Sami M.; Sisto, Jocelin; Gill, Kiranjeet

doi:10.1097/prs.0b013e31824a2bbd

Cited by 12 publications

(7 citation statements)

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“…Universal goals in all forms of reconstructive surgery, however, should include, wherever possible, minimizing scars, shortening operative time, and decreasing hospital stay. 23–27 This procedure has been described before 16,17 ; however, we hoped to describe clearly our personal technique that requires no endoscopic equipment and no patient repositioning and that can be performed using instruments available to all plastic surgeons around the world. This procedure enables us significant savings in operating time, with the reconstructive surgeon able to start operating with a second team after completion of the first side.…”

Section: Discussionmentioning

confidence: 99%

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The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

Lee

Miteff

2014

Plastic and Reconstructive Surgery Global Open

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Background:The evolution of surgical breast cancer treatment has led to the oncologically safe preservation of greater amounts of native skin, yet we are still often using flaps with large skin paddles, thereby resulting in significant donor-site scars. This explains the increasing appeal of acellular dermal matrix reconstructions. Acellular dermal matrices can, however, have significant problems, particularly if there is any vascular compromise of the mastectomy skin flaps. We have developed a method of raising the latissimus dorsi flap through the anterior mastectomy incisions without requiring special instruments or repositioning. This can provide autologous vascularized cover of the prosthesis.Methods:A clear surgical description of the scarless latissimus dorsi flap harvest is provided, and our results of a retrospective cohort review of 20 consecutive patients with 27 traditional latissimus dorsi breast reconstructions were compared with those of 20 consecutive patients with 30 scarless latissimus dorsi breast reconstructions.Results:Operative time, length of stay, and complication rates were reduced in the scarless group. Patients Breast-Q scores were equivalent in each group. The aesthetic assessment was good/excellent in 77% of both groups; however, subscale assessment was better in the scarless group. This was statistically significant (P = 0.0).Conclusions:Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices.

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Section: Discussionmentioning

confidence: 99%

“…This gives the security of fully vascularized coverage of the prosthesis in the event of skin necrosis. The scarless latissimus dorsi flap 16,17 can harvest a significant proportion of the latissimus dorsi using standard breast surgery instruments and without requiring endoscopic instrumentation. It has the added significant advantage of no donor scar.…”

mentioning

confidence: 99%

The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

Lee

Miteff

2014

Plastic and Reconstructive Surgery Global Open

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“…Bittar et al. also reported elevating the latissimus dorsi flap with an anterior approach successfully; however, their incision technique was different from ours ( 13 ).…”

Section: Discussionmentioning

confidence: 61%

“…Direct-toimplant reconstruction, however, requires confirmation of the symmetry between the reconstructed implant and the normal breast with the patient in the sitting position, as this cannot be achieved with the patient in the lateral position (12). Bittar et al also reported elevating the latissimus dorsi flap with an anterior approach successfully; however, their incision technique was different from ours (13).…”

Section: Discussionmentioning

confidence: 73%

A Retrospective Study of Latissimus Dorsi Flap in Immediate Breast Reconstruction

Zheng

Zhu²,

Guan³

et al. 2021

Front. Oncol.

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BackgroundThere are many different methods used for immediate breast reconstruction, but the advantages and disadvantages between distinct methods are not reported and compared directly.MethodsWe collected the data of patients who underwent breast reconstruction from 2010 to 2015 and classified a total of 103 patients into three groups: i) skin- or nipple-sparing mastectomy with implant and partial latissimus dorsi flap (MIPLD); ii) skin- or nipple-sparing mastectomy with the whole latissimus dorsi flap (MWLD); and iii) breast-conserving surgery and partial latissimus dorsi flap (BCSPLD). The outcome, safety, and cosmetic outcome of the latissimus dorsi muscle flap with or without implant were reported and compared.ResultsThe procedures were successful in all cases. None of the patients had severe complications. The 5-year distant metastasis-free survival is 94.2%. All the patients exhibited good arm and back function. Based on the evaluation of the BREAST-Q score, the cosmetic outcome of Satisfaction with Breasts was excellent or good in 97.8% of the cases.ConclusionsMIPLD, MWLD, and BCSPLD stand for three distinct methods for immediate breast reconstruction with good outcome and aesthetic effect. They were safe, were easy to perform, and provided quick recovery and good quality of life. Therefore, these three breast reconstructive methods are worthy of widespread use in clinical practice and provide different ways to reconstruct the breast according to the patients’ conditions and preferences.

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“…Use of latissimus dorsi flap combined with implants has been used for breast reconstruction; this combination method is most useful for patients with large volume breasts [4]. Recently, latissimus dorsi flap elevation alone via anterior approach and use of permanent implants with breast reconstructive surgery has been reported and exhibited acceptable results [5]. This method minimizes the back or abdominal scarring.…”

Section: Discussionmentioning

confidence: 99%

A case of breast reconstruction using waistline incisional extended latissimus dorsi muscle flap

et al. 2013

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Breast reconstruction using extended latissimus dorsi (ELD) flap often results in a large and somewhat conspicuous back scar, even though several surgical design modifications have been reported. Patients often complain of self-consciousness when wearing bikinis and a reluctance to visit pools or hot springs where the back scar would be easily seen. We performed a single-stage breast reconstruction operation in which the ELD muscle flap with cutaneous fat pad was elevated through a waistline incision. The patient underwent a nipple-sparing mastectomy by breast surgeons. The patient's breast volume was small, and the weight of excised breast tissue was 74 g. As a result of this small size, the latissimus dorsi muscle flap with subcutaneous fat pad alone had sufficient volume for the patient's breast reconstruction, and the flap was elevated through the patient's waistline incision. The patient's undergarments easily hid the waistline scar, and her back was scar-free. Patients with smaller sized breasts who undergo a nipple-sparing mastectomy procedure and choose not to use synthetic implants can achieve successful reconstruction results using the waistline incisional ELD muscle flap.

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Single-Stage Breast Reconstruction with the Anterior Approach Latissimus Dorsi Flap and Permanent Implants

Abstract: Therapeutic, IV.

Cited by 12 publications

References 0 publications

The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

A Retrospective Study of Latissimus Dorsi Flap in Immediate Breast Reconstruction

A case of breast reconstruction using waistline incisional extended latissimus dorsi muscle flap

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