J Breast Cancer.  2009 Sep;12(3):186-192. 10.4048/jbc.2009.12.3.186.

The Safety and Cosmetic Effect of Immediate Latissimus Dorsi Flap Reconstruction after Breast Conserving Surgery

• Kim S
• Lee S
• Lee H
• Lee J

• KMID: 2242010
• DOI: http://doi.org/10.4048/jbc.2009.12.3.186

Abstract

PURPOSE
Oncoplastic breast conserving surgery is a new concept in breast cancer surgery. We performed immediate latissimus dorsi flap reconstruction after breast conserving surgery (BCS) to get an adequate resection margin and a good cosmetic results. The aim of this study is to evaluate the effect of immediate latissimus dorsi flap reconstruction after BCS.
METHODS
From January to December, 2007, we performed BCS and immediate latissimus dosi myocutaneous flap reconstruction for 44 breast cancer patients. We evaluated the status of the post operative resection margin, the complications and the cosmetic results. The cosmetic results were evaluated with paying particular attention to the symmetry of the breasts, the breast shape, the location of the nipple and the post-operative scar by a three person panel that consisted of one doctor and two nurses.
RESULTS
Reoperation was performed in 3 patients out of 44 (6.8%) because of positive resection margin. Flap complications didn't occurred and donor-site complications such as seroma occurred in only 3 cases. The mean score for the overall cosmetic outcome by the panel was 7.03 (SD=1.36) out of 10 and the cosmesis was deemed to be fair for 52% and, good for 48%. The mean subjective score by the patients was 6.5 (SD=2.29) out of 10 and the cosmesis was deemed to be poor for 14%, fair for 46% and, good for 40%. The most influential factors for the overall cosmetic results were breast symmetry and shape, and the breast scar in descending order (p<0.05).
CONCLUSION
BCS with immediate latissimus dorsi flap reconstruction allows an adequate resection margin and good cosmetic results without serious complications.

Keyword

Latissimus myocutaneous flap; Mammaplasty; Segmental mastectomy

MeSH Terms

Breast
Breast Neoplasms
Cicatrix
Cosmetics
Female
Humans
Mammaplasty
Mastectomy, Segmental
Nipples
Reoperation
Seroma
Cosmetics

Figure

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  Figure 1 Post operative photographic results. (A) 45-yr-old woman with breast cancer in the upper outer quadrant of right breast. This shows good symmetry and shape. Panel score was 9 and patient score 8. (B) The result at 1 yr after the operation of right upper inner breast cancer and shows good symmetry and shape. Panel score was 9 and patient score 9. (C) This shows bigger right breast than left. Panel score was 6.33 and patient score 4. (D) This shows asymmetric inframammary fold after radiotherapy and prominent breast scar. Contralateral mastopexy is needed to get symmetry. Panel score was 5.33 and patient score 2. (E) This shows prominent hypertrophied back scar after 10 month. (F) This shows not so prominent back scar, 6 months after surgery.

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