Total autologous breast reconstruction in post mastectomy patients by Extended Latissimus Dorsi muscle flap

Abstract

Breast reconstruction has become more common procedure in recent years and many different techniques have been described; either using autologous tissue, that is with the body's own tissue, or by means of implants. The pedicled latissimus dorsi flap remains one of the most reliable methods of autologous breast reconstruction.

However, to achieve adequate breast volume, an implant is often required. In an attempt to convert the latissimus dorsi flap into a completely autologous method of breast reconstruction, several modifications have been described.

However, these techniques are not without complications. The low transverse extended latissimus dorsi flap modification presented in this study has several advantages over previous modifications. These include large flap volumes for reconstructing large breasts without the need for a prosthesis, improved back contour, reliable flap vascularity, and limited donor-site morbidity.This flap can also serve as a useful alternative to abdomen-based flaps, especially in obese patients with high risk factors for donor-site morbidity

Total autologous reconstruction of large breasts can be challenging. This difficulty is increased when obese patients are treated in whom abdomen-based flaps are not always suitable options. In this study, we have demonstrated anatomically and by photographic analysis the presence of distinct fat compartments within the back and their relative volumes. Using this knowledge, we propose our modification of the extended latissimus dorsi flap combined with a low transverse skin paddle design. With this method, obese patients underwent complete autologous breast reconstruction without implants and with minimal morbidity.

We also managed to confirm that delayed breast reconstruction is associated with increased incidence of flap loss, complications and small flap volume in comparision to immediate breast reconstruction.

Furthermore, this method encompasses all of the advantages of the traditional latissimus dorsi flap (i.e., long pedicle, large skin island surface area, and consistent anatomy with dependable vascularity) and decreases the disadvantages of the traditional extended latissimus dorsi flap. The low transverse extended latissimus dorsi flap provides a large flap volume with an aesthetically pleasing scar location and improved back silhouette. We believe this flap is a good solution for complete autologous breast reconstruction, particularly in obese patients, and should be considered in this challenging subgroup of patients. But the only point we need further researches on is to detect the actual volume of fat. Further modifications are required to minimize asymmetry from the contralateral breast side.