Immediate Breast Reconstruction with Latissimus Dorsi Flap and Implant: The Innovation of Flap Design and Transfer.

Abstract

Background: Modified radical mastectomy is the mainstream surgical treatment for breast cancer in which nipple-areolar complex and fusiform skin may be excised due to cancer invasion. Latissimus Dorsi (LD) flap combined with prosthesis implantation is a common method of immediate breast reconstruction after modified radical mastectomy. In this study, we introduced the design and transfer of flap based on the mastectomy incision for better practicality and appearance.

Methods: From January 2016 to December 2022, a retrospective analysis was performed in patients who received immediate breast reconstruction with LD flap and prosthesis implantation after modified radical mastectomy. The design of LD flap and its transfer were based on the incision of mastectomy and divided into two types: (1) Type I, transverse flap + rotational transfer-the incision of mastectomy was horizontal or from lower inner quadrant to upper outer quadrant, the skin paddle of LD flap was transversely oriented, and the flap was transpositioned with a 180 degree rotation of the skin paddle to cover the defect; (2) Type II, transverse flap + translational transfer-the incision of mastectomy was from upper inner quadrant to lower outer quadrant, the skin paddle of LD flap was transversely oriented, and the flap was transpositioned to the defect without rotation of the skin paddle. The length of the pedicle was adjusted to fit the flap transfer. The demographics, surgical technique, satisfaction score and complications were summarized and analyzed.

Results: 31 cases were included in the study, all being female patients with a mean age of 37.6 years. Patients were followed up for 6 to 48 months (mean, 21.2 months). Type I surgery was performed in 18 patients and type II in 13 patients. The average volume of the breast implant inserted was 195.16 ml. All flaps survived well. Seroma in donor site occurred in 5 of 18 type I patients and 3 of 13 type II patients, respectively. Mastectomy skin flap necrosis occurred in 1 type I patient and 1 type II patient. 4 patients reported shoulder weakness but recovered after rehabilitation training. In terms of satisfaction scores, the values of type I and type II group were 7.4 ± 1.4 and 8.5 ± 1.5, respectively, without statistical difference (p = 0.180).

Conclusion: Design and transfer of LD flap based on the mastectomy incision in immediate breast reconstruction with LD flap and prosthesis implantation facilitate surgical procedure and can achieve satisfactory results.

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