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Immediate Locally Advanced Breast Cancer and Chest Wall Reconstruction: Surgical Planning and Reconstruction Strategies with Extended V-Y Latissimus Dorsi Myocutaneous Flap

Munhoz, Alexandre Mendonça M.D.; Montag, Eduardo M.D.; Arruda, Eduardo M.D.; Okada, Alberto M.D.; Brasil, José Augusto M.D.; Gemperli, Rolf M.D., Ph.D.; Filassi, José Roberto M.D., Ph.D.; Ferreira, Marcus Castro M.D., Ph.D.

Plastic and Reconstructive Surgery: June 2011 - Volume 127 - Issue 6 - p 2186-2197
doi: 10.1097/PRS.0b013e318213a038
Breast: Original Articles

Background: Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons.

Methods: In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds.

Results: Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care.

Conclusions: The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management.

São Paulo, Brazil

From the Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine; Hospital Sírio-Libanês; and Cancer Institute of São Paulo, University of São Paulo.

Received for publication October 7, 2010; accepted November 24, 2010.

Disclosure: The authors do not have any financial or personal relationships that could inappropriately influence (bias) their work.

Alexandre Mendonça Munhoz, M.D.; Division of Plastic Surgery; University of São Paulo School of Medicine; Rua Mato Grosso; 306 cj.1705-1706; 01239-040 São Paulo, SP Brazil;

©2011American Society of Plastic Surgeons