CC BY-NC 4.0 · Arch Plast Surg 2020; 47(02): 135-139
DOI: 10.5999/aps.2019.01361
Original Article

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

Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
,
Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
,
Medion Hospital, Tashkent, Uzbekistan
,
Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
,
Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
,
Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
,
Breast Surgery Center, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Breast Surgery Center, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Department of Radiology, Pusan National University School of Medicine, Yangsan, Korea
,
Four Seasons Plastic Surgery Clinic, Busan, Korea
,
Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Yangsan, Korea
› Author Affiliations

Background This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy.

Methods We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18±4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P<0.05.

Results A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%–80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P<0.05). All cases were observed clinically for over 3 years.

Conclusions The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eLDMC flap if the LD is thick or if it occupies a large portion of the flap.

This study was supported by a grant of the clinical research fund of Pusan National University Yangsan Hospital in 2018.




Publication History

Received: 26 September 2019

Accepted: 23 December 2019

Article published online:
22 May 2022

© 2020. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • REFERENCES

  • 1 Fatah F. Extended latissimus dorsi flap in breast reconstruction. Oper Tech Plast Reconstr Surg 1999; 6: 38-49
  • 2 Menke H, Erkens M, Olbrisch RR. Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg 2001; 47: 107-14
  • 3 Chang DW, Youssef A, Cha S. et al. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 2002; 110: 751-9
  • 4 National Cancer Information Center. Cancer statistics [Internet]. Goyang: Ministry of Health and Welfare [cited 2018 Feb 13]. Available from: https://www.cancer.go.kr/
  • 5 Kang SY, Kim YS, Kim Z. et al. Basic findings regarding breast cancer in Korea in 2015: data from a Breast Cancer Registry. J Breast Cancer 2018; 21: 1-10
  • 6 Clough KB, Cuminet J, Fitoussi A. et al. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 1998; 41: 471-81
  • 7 Gart MS, Smetona JT, Hanwright PJ. et al. Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013; 216: 229-38
  • 8 Maxwell GP. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 1980; 65: 686-92
  • 9 Olivari N. The latissimus flap. Br J Plast Surg 1976; 29: 126-8
  • 10 Stone HB, Coleman CN, Anscher MS. et al. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 2003; 4: 529-36
  • 11 Nam SB, Oh HC, Choi JY. et al. Volumetric change of the latissimus dorsi muscle after immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap. Arch Plast Surg 2019; 46: 135-9