Arch Plast Surg.  2016 Mar;43(2):197-203. 10.5999/aps.2016.43.2.197.

Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

• Feng J
• Pardoe CI
• Mota AM
• Chui CH
• Tan BK

• KMID: 2159089
• DOI: http://doi.org/10.5999/aps.2016.43.2.197

Abstract

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.

Keyword

Breast; Reconstructive surgical procedures; Tissue expansion; Surgical flaps; Radiotherapy

MeSH Terms

Atrophy
Breast*
Cicatrix
Female
Humans
Mammaplasty*
Mastectomy
Muscular Atrophy
Radiotherapy
Reconstructive Surgical Procedures
Skin
Superficial Back Muscles*
Surgical Flaps
Tissue Expansion
Tissue Expansion Devices
Wounds and Injuries