Arch Plast Surg.  2018 Sep;45(5):484-489. 10.5999/aps.2017.01781.

A novel technique for large and ptotic breast reconstruction using a latissimus dorsi myocutaneous flap set at the posterior aspect, combined with a silicone implant, following tissue expander surgery

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan. ishinao0916@gmail.com
  • 2Department of Breast Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
  • 3Department of Plastic and Reconstructive Surgery, University of the Ryukyus Hospital, Naha, Japan.
  • 4Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan.

Abstract

Large and ptotic breast reconstruction in patients who are not candidates for a transverse rectus abdominalis myocutaneous flap and revision surgery for the contralateral breast remains challenging. We developed a novel breast reconstruction technique using a latissimus dorsi myocutaneous (LD m-c) flap set at the posterior aspect of the reconstructed breast, combined with an anatomical silicone breast implant (SBI), following tissue expander surgery. We performed the proposed technique in four patients, in whom the weight of the resected tissue during mastectomy was >500 g and the depth of the inframammary fold (IMF) was >3 cm. After over-expansion of the lower portion of the skin envelope by a tissue expander, the LD m-c flap was transferred to cover the lower portion of the breast defect and to achieve a ptotic contour, with the skin paddle set at the posterior aspect of the reconstructed breast. An SBI was then placed in the rest of the breast defect after setting the LD m-c flap. No major complications were observed during the follow-up period. The proposed technique resulted in symmetrical and aesthetically satisfactory breasts with deep IMFs, which allowed proper fitting of the brassiere, following large and ptotic breast reconstruction.

Keyword

Surgery, plastic; Reconstructive surgical procedures; Tissue transplantation; Mastectomy; Breast

MeSH Terms

Breast Implants
Breast*
Female
Follow-Up Studies
Humans
Mammaplasty*
Mastectomy
Myocutaneous Flap*
Reconstructive Surgical Procedures
Silicon*
Silicones*
Skin
Superficial Back Muscles*
Surgery, Plastic
Tissue Expansion Devices*
Tissue Transplantation
Silicon
Silicones
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