The Ergonomic FALD Flap for One-stage Total Breast Reconstruction

Abstract

Background: The fat-augmented latissimus dorsi (FALD) flap combines this pedicled flap with immediate intraoperative fat transfer. Very little is described concerning its inset at the mammary site. Our efforts have concentrated on seeking the best flap orientation and skin-adipose paddle shaping, to improve the aesthetic outcome and to obtain a complete breast reconstruction (BR) in one stage. Methods: A prospective clinical study was performed in patients who underwent BR with FALD flaps, between December 2020 and March 2022. Patients were randomly enrolled into two groups: ergonomic inset of the FALD flap with vertical orientation of the skin-adipose paddle (group A) and FALD flap with traditional horizontal paddle orientation (group B). The study’s endpoints were the evaluation of the aesthetic outcomes (from patients’ and surgeon’s perspectives) and complications. Results: Thirty-two FALD flaps (23 patients) were performed for group A, and 31 FALD flaps (25 patients) for group B. The two groups were homogeneous in terms of demographic and surgical data (P > 0.05). The overall complication rate was homogeneous among the groups, without statistically significant differences (P = 1.00). The surgeon’s assessments showed a statistically significant superior aesthetic outcome in group A regarding volume, symmetry, and shape (P < 0.05). Higher satisfaction was observed in group A patients, in terms of breast size (P < 0.00001), shape (P = 0.0049), and overall satisfaction (P = 0.00061). Conclusions: The ergonomic vertical FALD flap technique enables surgeons to perform one-stage total BR, with excellent breast projection and upper pole fullness. These refinements in flap shaping and molding reduced the need for further autologous fat transfer, obtaining a brilliant totally autologous BR without the need for microsurgical experience.

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.…”

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

“…Subsequently, the LD muscle is sutured as medially as possible, and a vacuum drain is left in the pocket. If the breast shows no skin deficiency, we prefer to orient the skin paddle vertically, 27 folding its distal third to support breast projection, considering that in secondary cases the lower pole is also implemented by AFT into the mastectomy flaps. Conversely, in case we need to add skin to the breast because of its deficiency, the orientation of the skin paddle will be horizontal to inset the skin within the previous mastectomy scar.…”