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  • Title: Single-stage breast reconstruction with the anterior approach latissimus dorsi flap and permanent implants.
    Author: Bittar SM, Sisto J, Gill K.
    Journal: Plast Reconstr Surg; 2012 May; 129(5):1062-1070. PubMed ID: 22544090.
    Abstract:
    BACKGROUND: Traditional latissimus dorsi myocutaneous flap breast reconstruction results in a large wound on the back, difficult inset of flap, and skin color disparity. An anterior approach to harvesting the latissimus dorsi muscle flap reduces morbidity, and with skin-sparing mastectomy, immediate single-stage reconstruction with a permanent implant is provided. METHODS: A retrospective review was performed of patients who underwent skin-sparing mastectomies and immediate reconstruction with the anterior approach latissimus dorsi muscle flap and permanent implant with 6- to 12-month follow-up. All procedures were performed by a single surgeon at three facilities from January of 2008 through December of 2008. Data included the patient's age; body mass index; history of axillary dissection, chemotherapy, or irradiation; occurrence of seroma, flap necrosis, infection, or cellulitis; and the need for further surgery. RESULTS: Fifty-eight reconstructions were performed in 36 patients (bilateral, 22 patients). Major complications included pulmonary embolism in one patient, removal of both implants in one patient because of infection, and removal of one implant because of hematoma. Minor complications included seroma in 40 of 58 procedures (68.9 percent), flap necrosis in seven (12 percent), cellulitis in four (6.8 percent), and a secondary procedure for cosmesis in four (6.8 percent). Seroma formation was more frequent in patients with a body mass index greater than 25 kg/m², patients aged older than 50 years, and after axillary dissection (p > 0.05). CONCLUSIONS: The anterior approach latissimus dorsi muscle flap with permanent implants provides a single-stage reconstructive option after skin-sparing mastectomy. Postoperative morbidity is comparable to that of the traditional latissimus dorsi muscle flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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