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. 2021 Aug;16(4):396-401.
doi: 10.1159/000511328. Epub 2020 Nov 4.

Multistage Latissimus Dorsi Flap with Implant for Complex Post-Mastectomy Reconstruction: An Old but Still Current Technique

Francesca De Lorenzi  1 , Francesco Borelli  1 , Pietro Sala  1 , Pietro Loschi  1 , Paola Naninato  2 , Anna Rita Vento  2 , Elisabetta Maria Cristina Rossi  2 , Paolo Veronesi  2
Affiliations

Multistage Latissimus Dorsi Flap with Implant for Complex Post-Mastectomy Reconstruction: An Old but Still Current Technique

Francesca De Lorenzi et al. Breast Care (Basel). 2021 Aug.

Abstract

Introduction: The latissimus dorsi (LD) flap has been used for reconstructing mastectomy defects since the early 1900s. Although its popularity has declined over the last decades, it still retains an important role in breast reconstruction. We present our recent experience with the multistage LD flap and implant for extremely complex post-mastectomy defects.

Patients and methods: Between 2011 and 2020, 42 consecutive patients underwent post-mastectomy LD reconstruction with an expander (STAGE 1). Some of them received prior fat-grafting of the mammary region (STAGE 0). All patients were scheduled for an expander-definitive implant change (STAGE 2). Some of them completed the program with fat-grafting, nipple and areola reconstruction, and other refinements (STAGE 3 or 4).

Results: Two patients underwent fat-grafting at STAGE 0. Mean age at STAGE 1 was 46.7 years, mean BMI was 23.6, 14.4% of the patients were smokers, and 21.4% had comorbidities. Immediate reconstructions were performed in 35.7% and delayed in 64.3%. Mean surgical time at STAGE 1 was 194.7 min for delayed reconstructions and 242.3 min for immediate ones. Mean hospital stay for STAGE 1 procedures was 3.8 days; all other STAGES were performed as ambulatory surgery. No flap necrosis was observed and only 1 patient required a surgical revision for bleeding. Dorsal seroma occurred in 45.2% of cases.

Conclusions: The multistage LD flap with implant is a useful and safe tool within the reconstructive armamentarium for post-mastectomy defects. It combines multiple simple procedures and does not require specific skills and surgical training (level of evidence 4).

Keywords: Breast reconstruction; Implant; Latissimus dorsi flap.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Patient flowchart and multistaged reconstruction.
Fig. 2
Fig. 2
1a: A 45-year-old woman presented with a 4-cm local relapse in her right breast after conservation. Right total mastectomy and LD and expander were planned. 1b: Final result after STAGE 3, after nipple and areola reconstruction and fat-grafting in the upper pole and internal quadrants. 1c: Postoperative view of the dorsal region. 2a: A 40-year-old woman after a bilateral nipple-sparing mastectomy and definitive implant. In the left breast, infection occurred after irradiation, requiring removal of the implant. 2b: Final result after STAGE 2, the same-sized implant was placed in the left breast. 2c: Postoperative view of the dorsal region. 3a: A 39-year-old woman after implant failure in the left breast after irradiation. 3b: Final result after STAGE 2. The patient is waiting for left fat-grafting and nipple and areola repositioning. 3c: Postoperative view of the dorsal region.
See this image and copyright information in PMC

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