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Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Munhoz, Alexandre Mendonça M.D.; Aldrighi, Claudia M.D.; Montag, Eduardo M.D.; Arruda, Eduardo Gustavo M.D.; Aldrighi, José Mendes M.D., Ph.D.; Filassi, José Roberto M.D., Ph.D.; Ferreira, Marcus Castro M.D., Ph.D.

Plastic and Reconstructive Surgery: May 2007 - Volume 119 - Issue 6 - p 1637-1649
doi: 10.1097/01.prs.0000246406.68739.e4
Breast: Original Articles

Background: Although use of the latissimus dorsi myocutaneous flap associated with the Biodimensional anatomical expander implant system (McGhan 150) is a reliable technique, little information has been available regarding clinical outcome following periareolar skin-sparing mastectomy reconstruction. The purpose of this study was to analyze the feasibility of the technique, surgical planning, and its outcome following skin-sparing mastectomy.

Methods: Thirty-two patients underwent immediate unilateral latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system breast reconstruction. Mean follow-up was 18 months. The technique was indicated in patients with small- or moderate-volume breasts with or without ptosis, in whom the use of abdominal flaps was precluded. Flap and donor-site complications were evaluated. Information on anesthetic results and patient satisfaction was collected.

Results: Seventy-two percent had tumors measuring 2 cm or less (T1) and 78 percent were stage 0 and I according to American Joint Committee on Cancer criteria. Breast skin complications occurred in 9.4 percent. Two patients presented small breast skin necrosis, and in one patient, a wound dehiscence was observed. Donor-site complications, all represented by seroma, occurred in 12.5 percent. The cosmetic result was considered good or very good in 84.4 percent, and the majority of patients were either very satisfied or satisfied. No local recurrences were observed. All complications except two were treated by conservative means.

Conclusions: The latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system is a simple and reliable technique for periareolar skin-sparing mastectomy reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative and postoperative management.

São Paulo, Brazil

From the Division of Plastic Surgery; University of São Paulo School of Medicine.

Received for publication July 24, 2005; accepted August 24, 2005.

Alexandre Mendonça Munhoz, M.D., Division of Plastic Surgery, University of São Paulo School of Medicine, Rua da Consolação 3605, ap. 91, 01416-001 São Paulo, Brazil, munhozalex@uol.com.br

©2007American Society of Plastic Surgeons