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
