Role of Latissimus Dorsi muscle in Breast Reconstruction

Abstract

Breast cancer is the commonest malignancy in women. It is the most common cause of cancer death among women worldwide. The female breast is a potent symbol of maternity and femininity. For many years after a mastectomy, many women experience psychological distress and feel that her everyday life has been disputed. Treatment of the breast carcinoma largely depends upon the clinical stage of the disease at the time of presentation including not only the classical TNM staging but also often other tumor characteristics such as tumor grading. Added to that the development of diagnosis, imaging (Mammography, Ultrasonography and breast MRI), invasive diagnostic technique (Fine needle biopsy, core needle biopsy, Incisional biopsy and Excisional biopsy) and different protocols to learn the women self-examination. The surgical treatment of patients with breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women. Breast reconstruction has become an important aspect of breast cancer management. The patient needs to be aware that the reconstructed breasts will neither feel nor function like a normal breast but may help in restoring body image and self confidence. OBS techniques include closure of the breast defect that resulted from tumor resection with glandular or dermoglandular flaps prepared within the breast and reshaping of breast OR filling of the breast defect with the patient’s own tissues from areas away from the breast. The last is used in patients with large tumor/breast volume ratio, those with deficient breast volume after resection, and those with significant breast defect. The patient's choice will depend on the available options in the breast unit where she is being treated, which in turn will depend on the experience and attitude of the breast surgeon. Latissimus Dorsi myocutaneous flap is an example of a breast volume filling technique. The LD myocutaneous flap allows for the reconstruction of a full range of breast volumes. Advantages of LD flap in breast reconstruction 1. Because of their vascular supply from the thoracodorsal vessels, LD flaps have reliable survival. 2. When used as pedicled flaps, LD flaps eliminate the need for microsurgery. 3. LD flaps can be customized, with variations that include full muscle myocutaneous, split-muscle myocutaneous, muscle only, and skin-and-fat-only flaps. 4. LD flaps are viable options for patients who have undergone radiotherapy. 5. LD flaps are good options for patients who are not candidates for abdominal flap-based reconstruction. 6. LD flaps can be used for chest wall coverage or as salvage therapy after a previous breast reconstruction has failed. A lot of operative techniques use LD flap in breast reconstruction. They are:  Full-muscle myocutaneous flap.  Split LD flap.  Thoracodorsal artery perforator flap.  Muscle Sparing LD flap.  Extended LD flap.  LD miniflap. Complications Complications associated with breast reconstruction: They include flap failure, fat necrosis, muscle weakness, excessive bleeding, lymphedema and delayed healing. Complications in donor site: They include seroma formation, infection and hypertrophic scar.