Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

The Latissimus Dorsi Myocutaneous Flap Is a Safe and Effective Method of Partial Breast Reconstruction in the Setting of Breast-Conserving Therapy

Mericli, Alexander F., M.D.; Szpalski, Caroline, M.D., Ph.D.; Schaverien, Mark V., M.D.; Selber, Jesse C., M.D., M.P.H.; Adelman, David M., M.D.; Garvey, Patrick B., M.D.; Villa, Mark T., M.D.; Robb, Geoffrey, M.D.; Baumann, Donald P., M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 927e–935e
doi: 10.1097/PRS.0000000000005577
Breast: Original Articles
Buy
SDC

Background: Reconstruction of partial breast defects in low-volume, nonptotic breasts can be challenging. The authors hypothesized that use of the latissimus dorsi flap in partial breast reconstruction is safe and associated with low complication and high patient satisfaction rates.

Methods: All patients who underwent breast-conserving therapy and latissimus dorsi flap reconstruction from January 1, 2006, to December 31, 2016, were identified in a prospectively maintained database. Patient demographics, tumor characteristics, and complications were recorded. Patient-reported outcomes were assessed with the BREAST-Q breast-conserving therapy module. A group of plastic surgeons and laypersons used a five-point Likert scale to evaluate aesthetic outcomes in representative patients.

Results: Forty-seven patients met the inclusion criteria. Median follow-up was 5.4 years. Most patients (93.6 percent) underwent immediate reconstruction. The mean resection volume was 219.5 cc (range, 70 to 877 cc). The overall complication rate was 8.5 percent. Grade 2 or 3 ptosis (OR, 1.21; 95 percent CI, 1.0 to 1.46; p = 0.03), smoking (OR, 13.1; 95 percent CI, 1.2 to 143.2; p = 0.03), and multicentric tumor (OR, 1.23; 95 percent CI, 1.04 to 1.64; p = 0.02) were associated with a higher complication rate. Ductal carcinoma in situ was associated with reoperation for positive margins (OR, 14.4; 95 percent CI, 2.1 to 100; p = 0.009). Of particular interest, patient-reported outcomes were favorable, with the highest rated domains being Satisfaction with Breasts (61; interquartile range, 37 to 77), Psychosocial Well-being (87; interquartile range, 63 to 100), and Physical Well-being (87; interquartile range, 81 to 100). The median aesthetic score was 4 (of 5).

Conclusions: This is the first study to date using the BREAST-Q to assess patient-reported outcomes associated with the latissimus dorsi flap for partial breast reconstruction. The flap is safe and effective for reconstruction in the setting of breast-conserving therapy, providing aesthetically pleasing results with high patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication February 25, 2018; accepted September 10, 2018.

Dr. Mericli and Dr. Szpalski should be considered co–first authors.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Alexander F. Mericli, M.D., Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, Texas 77030, afmericli@mdanderson.org

©2019American Society of Plastic Surgeons