DOI: http://dx.doi.org/10.18203/2349-2902.isj20201548

Post mastectomy breast reconstruction with autologous latissimus dorsi flap: a study of 30 cases

Shipra Singla, Vikas Kakkar, Rana Ranjit Singh

Abstract


Background: There is a growing demand for breast reconstruction and among the plethora of breast reconstruction techniques, the latissimus dorsi (LD) flap is a versatile, reliable means for soft tissue coverage, providing form and function with acceptable perioperative and long-term morbidities for a variety of breast defects. The aim of this study was to find out the advantages of immediate breast reconstruction in terms of postoperative morbidity and patient satisfaction with respect to her expectations.

Methods: The study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar. Thirty female patients who had undergone immediate breast reconstruction with latissimus dorsi flap after modified radical mastectomy attending surgery department from November 2017 to September 2019 were taken. The follow up was done to find out post-operative complications and a statistical scoring was done according to rating scale of quality of life.

Results: Most common complication after breast reconstruction with LD flap was found to be seroma formation (50%) followed by wound infection and flap necrosis 25% each while flap necrosis >20% was not found in any case. For emotional feeling regarding health, social activities, overall health and quality of life; there was significant improvement after surgery.

Conclusions: It can be concluded that immediate breast reconstruction with autologous latissimus dorsi flap is the treatment of choice following mastectomy in cases of breast carcinoma, whenever possible.


Keywords


Autologous, Carcinoma, Flap necrosis, Immediate breast reconstruction, Latissimus dorsi, Mastectomy

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References


Newman B, Austin MA, Lee M, King MC. Inheritance of human breast cancer: evidence for autosomal dominant transmission in high-risk families. Proc Natl Acad Sci USA. 1988;85(9):3044-8.

Claus EB, Schildkraut JM, Thompson WD, Risch NJ. The genetic attributable risk of breast and ovarian cancer. Cancer. 1996;77(11):2318-24.

Vetto J, Pommier R, Schmidt W, Wachtel M, DuBois P, Jones M, et al. Use of the “triple test” for palpable breast lesions yields high diagnostic accuracy and cost savings. Am J Surg. 1995;169(5):519-22.

Hennessy BT, Gonzalez-Angulo AM, Hortobagyi GN, Cristofanilli M, Kau SW, Broglio K, et al. Disease-free and overall survival after pathologic complete disease remission of cytologically proven inflammatory breast carcinoma axillary lymph node metastases after primary systemic chemotherapy. Cancer. 2006;106(5):1000-6.

Schover LR. Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr. 1994;16(16):177-82.

Bowman CC, Lennox PA, Clugston PA, Courtemanche DJ. Breast reconstruction in older women: should age be an exclusion criterion? Plast Reconstr Surg. 2006 l;118(1):16-22.

Slavin SA, Schnitt SJ, Duda RB, Houlihan MJ, Koufman CN, Morris DJ, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg. 1998;102(1):49-62.

Rainsbury RM. Skin-sparing mastectomy. Br J Surg. 2006;93(3):276- 81.

Kroll SS, Khoo A, Singletary SE, Ames FC, Wang BG, Reece GP, et al. Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg. 1999;104(2):421-5.

Carlson GW, Styblo TM, Lyles RH, Bostwick J, Murray DR, Staley CA, et al. Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism? Ann Surg Oncol. 2003;10(2):108-12.

Fernández-Delgado J, López-Pedraza MJ, Blasco JA, Andradas- Aragones E, Sánchez-Méndez JI, Sordo-Miralles G, et al. Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Ann Oncol. 2008;19(8):1430-4.

Lewis RS, Kontos M. Autologous tissue immediate breast reconstruction: desired but oncologically safe? Int J Clin Pract. 2009;63(11):1642-6.

Teisch LF, Gerth DJ, Tashiro J, Golpanian S, Thaller SR. Latissimus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction: outcomes. J Surg Res. 2015;199(1):274-9.

Lindegren A, Halle M, Docherty Skogh AC, Edsander-Nord A. Postmastectomy breast reconstruction in the irradiated breast: a comparative study of DIEP and latissimus dorsi flap outcome. Plast Reconstr Surg. 2012;130(1):10-8.

Fischer JP, Nelson JA, Au A. CT III T, Serletti JM, Wu LC. Complications and morbidity following breast reconstruction-a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg. 2014;48(2):104-14.

Hokin JA, Silfverskiold KL. Breast reconstruction without an implant: results and complications using an extended latissimus dorsi flap. Plast Reconstr Surg. 1987;79(1):58-66.

Spear SL, Clemens MW. Latissimus dorsi flap breast reconstruction. In: Neligan PC, Grotting JC, Ed. Plastic Surgery. 3rd ed. Philadelphia, PA: Saunders (Elsevier); 2012: 370-392.

Hammond DC. Latissimus dorsi flap breast reconstruction. Clin Plast Surg. 2007;34(1):75-82.

Menke H, Erkens M, Olbrisch RR. Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg. 2001;47(2):107-14.

Paredes C, Peixoto D, Amorim D, Araujo J, Barreto P. The impact of breast reconstruction on the quality of life of patients after mastectomy at the Plastic Surgery Service of Walter Cantidio University Hospital. Revista Brasileira de Cirurgia Plastica. 2001;28(1):100-4.

Kapil H, Rajderkar SS. Clinico-epidemiological profile of female breast cancers and its important correlates: A hospital based study. Natl J Community Med. 2012;3(2):316-20.

Fernández-Frías AM, Aguilar J, Sánchez JA, Merck B, Piñero A, Calpena R. Immediate reconstruction after mastectomy for breast cancer: which factors affect its course and final outcome? J Am Coll Surg. 2009;208(1):126-33.

Reuben BC, Manwaring J, Neumayer LA. Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States. Am J Surg. 2009;198(2):237-43.

Panieri E, Lazarus D, Dent DM, Hudson DA, Murray E, Werner ID. A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma. Am Surg. 2003;69(2):95-7.

Barnett GR, Gianoutsos MP. The latissimus dorsi added fat flap for natural tissue breast reconstruction: report of 15 cases. PlastReconstr Surg. 1996;97(1):63-70.

De Mey A, Lejour M, Declety A, Meythiaz AM. Late results and current indications of latissimus dorsi breast reconstructions. Br J Plast Surg. 1991;44(1):1-4.

Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study. PlastReconstr Surg. 2003;111(3):1060-8.

Frey JD, Salibian AA, Karp NS, Choi M. Examining length of hospital stay after microsurgical breast reconstruction: evaluation in a case-control study. Plastic and Reconstructive Surgery Global Open. 2017;5(12).

Sarwer DB. Psychological Aspects of Reconstructive and CosmeticPlasticSurgery: Clinical, Empirical, and Ethical Perspectives. Phil-adelphia: Lippincott Williams & Wilkins; 2006;12:23-4.

Guyomard V, Leinster S, Wilkinson M. Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast. 2007;16(6):547-67.

Wellisch DK, Schain WS, Noone RB, Little JW 3rd. Psychosocialcorrelates of immediate versus delayed reconstruction of the breast. PlastReconstr Surg. 1985;76(5):713-8.