Volumetric change of the latissimus dorsi muscle after immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap

Background In immediate breast reconstruction using an extended latissimus dorsi musculocutaneous (eLDMC) flap, the volume of the flap decreases, which causes a secondary deformity of the breast shape. Since little research has investigated this decrease in muscle volume, the authors conducted an objective study to characterize the decrease in muscle volume after breast reconstruction using an eLDMC flap.

Methods Research was conducted from October 2011 to November 2016. The subjects included 23 patients who underwent mastectomy due to breast cancer, received immediate reconstruction using an eLDMC flap without any adjuvant chemotherapy or radiotherapy, and received a computed tomography (CT) scan from days 7 to 10 after surgery and 6 to 8 months postoperatively. In 10 patients, an additional CT scan was conducted 18 months postoperatively. Axial CT scans were utilized to measure the volumetric change of the latissimus dorsi muscle during the follow-up period.

Results In the 23 patients, an average decrease of 54.5% was observed in the latissimus dorsi muscle volume between the images obtained immediately postoperatively and the scans obtained 6 to 8 months after surgery. Ten patients showed an average additional decrease of 11.9% from 6–8 months to 18 months after surgery.

Conclusions We studied changes in the volume of the latissimus dorsi muscle after surgery using an eLDMC flap performed after a mastectomy without adjuvant chemotherapy or radiotherapy. In this study, we found that immediate breast reconstruction using a latissimus dorsi muscle flap led to a decrease in muscle volume of up to 50%.

Keywords

Mammaplasty - Superficial back muscles - Myocutaneous flap

This work was supported by a 2015 clinical research grant from Pusan National University Yangsan Hospital.

Publication History

Received: 15 November 2017

Accepted: 22 October 2018

Article published online:
03 April 2022

• REFERENCES

• 1 Azzawi K, Ismail A, Earl H. et al. Influence of neoadjuvant chemotherapy on outcomes of immediate breast reconstruction. Plast Reconstr Surg 2010; 126: 1-11
• 2 Mosahebi A, Ramakrishnan V, Gittos M. et al. Aesthetic outcome of different techniques of reconstruction following nipple-areola-preserving envelope mastectomy with immediate reconstruction. Plast Reconstr Surg 2007; 119: 796-803
• 3 Saulis AS, Mustoe TA, Fine NA. A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 2007; 119: 1669-76
• 4 Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg 2012; 39: 509-13
• 5 Kim H, Wiraatmadja ES, Lim SY. et al. Comparison of morbidity of donor site following pedicled muscle-sparing latissimus dorsi flap versus extended latissimus dorsi flap breast reconstruction. J Plast Reconstr Aesthet Surg 2013; 66: 640-6
• 6 Yezhelyev M, Duggal CS, Carlson GW. et al. Complications of latissimus dorsi flap breast reconstruction in overweight and obese patients. Ann Plast Surg 2013; 70: 557-62
• 7 Kaariainen M, Giordano S, Kauhanen S. et al. The significance of latissimus dorsi flap innervation in delayed breast reconstruction: a prospective randomized study-magnetic resonance imaging and histologic findings. Plast Reconstr Surg 2011; 128: 637e-645e
• 8 Paolini G, Longo B, Laporta R. et al. Permanent latissimus dorsi muscle denervation in breast reconstruction. Ann Plast Surg 2013; 71: 639-42
• 9 Szychta P, Butterworth M, Dixon M. et al. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap. Breast 2013; 22: 667-72