Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

Abstract

BackgroundBreast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.MethodsFrom September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.ResultsThe average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.ConclusionsPartial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

The Lateral Thoracodorsal Flap in Delayed Bilateral Breast Reconstruction for an Obese Patient with Redundant Lateral Chest Wall Soft Tissue

“…The lateral thoracodorsal flap procedure has the advantage of being similar in color and texture to the native breast; in addition, morbidity of the donor site is minimized without sacrificing muscles or nerves, implying less invasiveness, a shorter hospital stay, and good aesthetic and functional results [1][2][3][4]7,8]. Furthermore, it could reduce the operating time in case of both breast surgery or patients with obesity.…”

“…Care must be taken in high-risk patients such as smokers and patients with associated comorbid diseased. In addition, it is prudent to evaluate dermal bleeding in the tip of the flap and shorten it if necessary to avoid partial [2][3][4]7,8].…”

“…Described as a fasciocutaneous flap in the 1980s, the lateral thoracodorsal flap is a well studied procedure for late breast reconstruction following radical surgery. It relies on the redundancy of skin that can be pinched together without transferring tension on the mammary region [1][2][3][4]. We report the case of bilateral thoracodorsal flap with cohesive gel implant performed to woman who had redundant lateral chest wall soft tissue after modified radical mastectomy.…”

Another Option of Perforator Flap in the Lateral Thoracic Area: Lateral Thoracic Perforator Flap

“…In females, the lateral thoracic artery is large and has lateral mammary branches to the mammary gland. [20][21][22][23] The direct cutaneous perforators form the lateral thoracic artery provide the third perforator flap option, the so-called LTp in the lateral thoracic area between the two muscle borders of the pectoralis major and LD muscles. 10 In our series, the LTp flap was not the flap of first choice.…”

Perforator Flap versus Conventional Flap

“…According to the our nomenclature, flaps based on a septocutaneous perforator or direct cutaneous perforator are named after the proximal vessel, while flaps based on the musculocutaneous perforator are named after the muscle ( 10 , 31 ). Accordingly, the 'latissimus dorsi perforator flap' signifies the perforator flap based on the musculocutaneous perforator, the 'thoracodorsal perforator flap' is the perforator flap based on the septocutaneous perforator, and the 'lateral thoracic perforator flap' is based on the direct cutaneous perforator from the lateral thoracic artery ( 10 , 33 ). Therefore, the conventional donor site of muscle or myocutaneous flaps turns into a "universal donor site" in the context of the perforator concept.…”