Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking
breast with symmetry. The latissimus dorsi (LD) flap with implant is an established
technique for this purpose. However, it is challenging to obtain adequate volume and
satisfactory aesthetic results using a one-stage operation when considering factors
such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction
addresses these difficulties by using a tissue expander to gradually enlarge the skin
pocket which eventually holds an appropriately sized implant.
Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction.
In the first stage, an expander was placed along with the LD flap to reconstruct the
mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of
the skin pocket. The final implant volume was determined by measuring the residual
expander volume after aspirating the excess saline. Finally, the expander was replaced
with the chosen implant.
Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed
an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle.
Seven patients scored less than six on the relative breast retraction assessment formula
for breast symmetry, indicating excellent breast symmetry. The remaining two patients
scored between six and eight, indicating good symmetry.
Conclusions This approach allows the size of the eventual implant to be estimated after the
skin pocket has healed completely and the LD muscle has undergone natural atrophy.
Optimal reconstruction results were achieved using this approach.
Keywords
Breast - Reconstructive surgical procedures - Tissue expansion - Surgical flaps -
Radiotherapy
