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J Reconstr Microsurg 2017; 33(07): 455-465
DOI: 10.1055/s-0037-1601379
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tips and Tricks to Improve Clinical and Aesthetic Outcomes in Latissimus Dorsi Flap Breast Reconstruction

Rosaria Laporta
1   Department of Plastic Surgery, Sant'Andrea Hospital, School of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
,
Michail Sorotos
1   Department of Plastic Surgery, Sant'Andrea Hospital, School of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
,
Benedetto Longo
1   Department of Plastic Surgery, Sant'Andrea Hospital, School of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
,
Fabio Santanelli di Pompeo
1   Department of Plastic Surgery, Sant'Andrea Hospital, School of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
› Author Affiliations
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Publication History

20 August 2016

23 February 2017

Publication Date:
03 April 2017 (online)

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Abstract

Background The aim of this study is to present technical strategies to decrease donor-site complications, to optimize breast shaping, and to achieve symmetry in one-stage procedure in latissimus dorsi (LD) flap reconstruction.

Methods Between 2004 and 2014, a retrospective review was performed on LD flap reconstructions. Demographics, reconstructive details, clinical and aesthetic outcomes were collected and analyzed. Patients were divided in historical control group (HCG) and new strategy group (NSG). In HCG, a horizontal/oblique LD skin paddle (SP) was drawn; only LD muscle was harvested for the implant pocket; and a contralateral symmetrization was planned without any algorithm. In NSG, a transverse LD-SP was centered on the middle to lower bra strap area; a double-layer muscle coverage was used to create the implant pocket; and a planning algorithm was developed to achieve symmetry.

Results A total of 418 breast reconstructions were performed on 296 patients. The two groups were homogeneous regarding demographics, mastectomy weight, and implant volume (p > 0.05). No differences were observed in the incidence of a contralateral surgery, mean hospitalization time, and mastectomy skin flap and nipple–areola complex complications (p > 0.05), while surgical revision of the balancing procedure was more common in HCG than NSG (p = 0.001). Overall, donor-site morbidities occurred in 50 cases including 3 (1%) seroma in NSG and 17 (14.1%) in HCG, and 8 (2.7%) wound dehiscence in NSG and 18 (14.5%) in HCG (p = 0.001). Mean number of take backs to the operating room for secondary procedure was statistically significant between the groups in favor of NSG (p = 0.001).

Conclusion Careful preoperative planning and adoption of appropriate reconstructive strategies can improve clinical and aesthetic outcomes in LD flap breast reconstruction at long-term follow-up.

Level of Evidence This is a level III, therapeutic study.

Keywords

breast reconstruction - donor-site complications - LD flap - fat grafting - implant complications
 

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