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. 2021 Oct 22;9(10):e3887.
doi: 10.1097/GOX.0000000000003887. eCollection 2021 Oct.

Scarless Total Breast Reconstruction with a Fat-augmented Latissimus Dorsi Flap

Kosuke Maitani  1 , Koichi Tomita  2 , Mifue Taminato  2 , Tateki Kubo  2
Affiliations

Scarless Total Breast Reconstruction with a Fat-augmented Latissimus Dorsi Flap

Kosuke Maitani et al. Plast Reconstr Surg Glob Open. .

Abstract

Total breast reconstruction with a fat-augmented latissimus dorsi flap (F-LDF) is a breakthrough approach that surmounts the shortcomings of the latissimus dorsi flap (LDF), such as volume insufficiency. Unlike the abdominal flap, the LDF can be harvested as a sole muscle flap without a skin paddle. This makes it possible to perform breast reconstruction with no donor-site scar when breast skin replacement is not required (eg, nipple-sparing mastectomy, two-stage reconstruction using a tissue expander). Here we describe a new approach for total breast reconstruction, namely scarless F-LDF reconstruction. First, the dorsal and ventral planes of the LDF are widely dissected through an inferolateral incision with monopolar electrocautery. The origin of the muscle is then separated using an energy-based device inserted through a stab incision, and immediate fat grafting is performed concurrently to the LDF and pectoralis major muscle. This new method was used in five cases, with a mean specimen weight of 285 g (range, 181-420), mean flap weight of 174 g (125-230), mean total fat graft volume of 214 ml (126-335), and mean duration of reconstruction surgery of 213 minutes (161-260). In all cases, sufficient volume was obtained postoperatively with satisfactory esthetic results. In addition to avoiding a donor-site scar, this method could reduce postoperative pain and donor-site seroma. The scarless F-LDF can be used for total breast reconstruction in certain populations, especially in cases requiring no skin replacement and for small- to medium-sized breasts.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Our method is applicable only in cases where an inferolateral incision has been made for mastectomy (red arrow), and the end of the incision is as low as the inframammary fold (blue arrowhead).
Fig. 2.
Fig. 2.
Dissection of the LDM. From the inferolateral incision, the ventral plane of the LDM is first dissected with monopolar electrocautery (A). Next, while pulling the lateral edge of the LDM with forceps, the dorsal plane of the LDM (just below the superficial fascia) is dissected (B).
Fig. 3.
Fig. 3.
Division of the origin of the LDM. First, the lateral edge of the LDM is divided with monopolar cautery (arrow 1), and further division proceeds from the caudal border (arrow 2) to the medial boarder (arrow 3) of the LDM using an energy-based device inserted through a stab incision at the lateral chest.
See this image and copyright information in PMC

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