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Latissimus dorsi flap breast reconstruction

Summer E Hanson, Benjamin D Smith, Jun Liu, Geoffrey L Robb, Steven J Kronowitz, Patrick B Garvey
: The most commonly chosen flaps for delayed breast reconstruction after postmastectomy radiation therapy (PMRT) are abdominal-based free flaps (ABFFs) and pedicled latissimus dorsi (LD) musculocutaneous flaps. The short-and long-term advantages and disadvantages of delayed ABFFs versus LD flaps after PMRT remain unclear. We hypothesized that after PMRT, ABFFs would result in fewer postoperative complications and a lower incidence of revision surgery than LD flaps. METHODS: We retrospectively reviewed a prospectively maintained database of consecutive patients who underwent unilateral, delayed breast reconstruction after PMRT using ABFFs or pedicled LD flaps with implants at the MD Anderson Cancer Center between January 1, 2001, and December 31, 2011...
September 2016: Plastic and Reconstructive Surgery. Global Open
Gül Alço, Sefik Igdem, Sait Okkan, Maktav Dincer, Dauren Sarsenov, Ahmet Serkan Ilgun, Filiz Agacayak, Filiz Elbüken, Tulay Ercan, Derya Selamoglu, Vahit Ozmen
The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips...
October 2016: Molecular and Clinical Oncology
Gui-Yong Park, Eul-Sik Yoon, Hee-Eun Cho, Byung-Il Lee, Seung-Ha Park
BACKGROUND: The objective of this paper was to describe a novel technique for improving the maintenance of nipple projection in primary nipple reconstruction by using acellular dermal matrix as a strut in one of three different configurations, according to the method of prior breast reconstruction. The struts were designed to best fill the different types of dead spaces in nipple reconstruction depending on the breast reconstruction method. METHODS: A total of 50 primary nipple reconstructions were performed between May 2012 and May 2015...
September 2016: Archives of Plastic Surgery
Jeong Tae Kim, Youn Hwan Kim, Sang Wha Kim
INTRODUCTION: Fibrin sealants have had applications in hemostasis, cohesion, and promotion of healing in plastic surgery. In this article, we review cases where fibrin sealant was used to stabilize microvascular pedicles and compared with previous free flaps performed without fibrin sealant. METHODS: Between 2008 and 2010, 62 consecutive patients underwent free tissue transfer for reconstruction; this involved 33 latissimus dorsi perforator flaps, 14 thoracodorsal artery perforator flaps, 9 latissimus dorsi myocutaneous flaps, 3 lateral thoracic artery perforator flaps, and 3 transverse rectus abdominis myocutaneous flaps, used in head and neck reconstruction, lower limb reconstructions, breast reconstructions, and facial palsy reconstruction...
September 16, 2016: Microsurgery
A de Runz, D Boccara, F Bekara, M Chaouat, M Mimoun
BACKGROUND: Delayed breast reconstruction with tissue expansion may be risky after radiotherapy, due to the poor skin quality. To permit the use of the tissue expansion procedure, we propose a scarless latissimus dorsi flap to bring tissue trophicity, by a healthy vascularized muscular interface with no donor scar and no patch effect. The objective of this study is to assess the outcome of the tissue expansion technique with scarless latissimus dorsi flap after post-mastectomy radiotherapy...
September 7, 2016: Annales de Chirurgie Plastique et Esthétique
Joseph I Chen, Camille G Cash, Al-Haj Iman, Aldona J Spiegel, Ernest D Cronin
Nipple-areola reconstruction is often one of the final but most challenging aspects of breast reconstruction. However, it is an integral and important component of breast reconstruction because it transforms the mound into a breast. We performed 133 nipple-areola reconstructions during a period of 4 years. Of these reconstructions, 76 of 133 nipple-areola complexes were reconstructed using the keyhole flap technique. The tissue used for the keyhole dermoadipose flap technique include transverse rectus abdominus myocutaneous flaps (60/76), latissimus dorsi flaps (15/76), or mastectomy skin flaps after tissue expanders (1/76)...
May 2016: Plastic and Reconstructive Surgery. Global Open
E Delay, S La Marca, S Guerid
Breast deformity of Poland syndrome is a malformation known to be difficult to treat. Numerous descriptions of surgical corrections have been published but none achieved to correct severe cases before description of lipomodeling technique. The aim of this article is to present thoraco-mammary deformity of Poland syndrome, corrections techniques already available and therapeutical indications in primary and secondary cases. Constant anomaly of Poland syndrome is agenesis of sternocostal part of pectoralis major muscle but other muscular anomalies can be associated...
October 2016: Annales de Chirurgie Plastique et Esthétique
Yoshihiro Sowa, Toru Morihara, Rie Kushida, Koichi Sakaguchi, Tetsuya Taguchi, Toshiaki Numajiri
BACKGROUND: Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3 years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT)...
July 5, 2016: Breast Cancer: the Journal of the Japanese Breast Cancer Society
H Eyjolfsdottir, B Haraldsdottir, M Ragnarsdottir, K S Asgeirsson
BACKGROUND: To prospectively assess the functional effect of using the extended latissimus dorsi flap in immediate breast reconstructions. MATERIALS AND METHODS: A total of 15 consecutive patients undergoing breast reconstruction with extended latissimus dorsi flap participated. Shoulder range of motion, muscle strength, lateral flexion of the torso, and position of scapula were measured pre-operatively and 1, 6, and 12 months post-operatively, in addition to donor-site post-operative complications...
July 1, 2016: Scandinavian Journal of Surgery: SJS
Jeeyeon Lee, Youngtae Bae, Jin Hyang Jung, Wan Wook Kim, Seung Ook Hwang, Taek Ju Kwon, Jin Ho Chung, Ho Yong Park, Seokwon Lee, Younglae Jung
BACKGROUND: Although breast reconstruction using a deep inferior artery perforator flap has been increasing, using a latissimus dorsi (LD) muscle flap is still the favored method for Asian female patients with breast cancer. However, because the incidence of donor site seromas has been relatively high, a quilting method on the donor cavity or insertion of drainage tube has been used to reduce the incidence and/or severity of postoperative seroma. We evaluated the effects of different intervals of quilting sutures on the postoperative drainage volume and components of seroma fluid...
June 7, 2016: Clinical Breast Cancer
Alessandro Sanguinetti, Andrea Polistena, Giovanni Bistoni, Roberta Lucchini, Massimo Monacelli, Roberta Triola, Stefano Avenia, Ivan Barillaro, Roberto Cirocchi, Nicola Avenia
INTRODUCTION: Some techniques for the total reconstruction of the breast, regardless of the complexity, have specific complications, with varying degrees of morbidity. Therefore, we wanted to identify the most frequent complications of the main techniques used for breast reconstruction, and compare the relation to the relevant independent variables. METHODS: Our study was conducted by examining the medical records of patients who had received complete reconstruction of the breast after a mastectomy due to breast cancer from January 2008 to December 2010, with a minimum follow-up of 3 years postoperatively...
February 29, 2016: Annali Italiani di Chirurgia
J Correia Anacleto, C Mavioso, P F Gouveia, A Magalhães, J Bastos Martins, A Moura, D Pinto, M J Cardoso
UNLABELLED: The latissimus dorsi flap is a commonly used tissue transfer for volume replacement in partial or total breast reconstruction. In this era of cosmetic awareness and oncoplastic breast surgery, two main defects are related to the conventional technique: the back scar and the bulkiness on the lateral chest wall, under the axilla. Axillary bulking, a disturbing defect for the majority of patients, is a persistent consequence, independent of the technique used, even when the proximal tendon is cut...
August 2016: Aesthetic Plastic Surgery
Nai-Si Huang, Chen-Lian Quan, Lin-Xiao-Xi Ma, Jing Si, Jia-Jian Chen, Ben-Long Yang, Xiao-Yan Huang, Guang-Yu Liu, Zhen-Zhou Shen, Zhi-Min Shao, Jiong Wu
BACKGROUND: Since mastectomy remained the primary strategy for treating breast cancer in China, post-mastectomy reconstruction is of great importance in the Chinese population. The current study aimed to assess the current status of breast reconstruction in China. METHODS: We reviewed all patients who received breast reconstruction from August 2000 to July 2015 in the Department of Breast Surgery in our institute. Patients' baseline characteristics, reconstruction strategy, final pathology and loco-regional recurrence (LRR) information were collected...
June 2016: Gland Surgery
Yoshihiro Sowa, Toshiaki Numajiri, Ayako Kawarazaki, Kouichi Sakaguchi, Tetsuya Taguchi, Kenichi Nishino
BACKGROUND: Postoperative seroma is the most common complication of latissimus dorsi (LD) flap surgery for breast reconstruction. The use of EC for elevation of the flap might cause additional risk for seroma formation by injuring surrounding lymph vessels due to heat dispersion. There is a possibility that seroma formation can be prevented by using alternative devices such as harmonic focus (HF) shears that can dissect the tissue simultaneously with sealing the lymph vessels. METHODS: Forty-eight patients who underwent breast reconstruction with LD flaps since August 2011 up to April 2015 were enrolled...
May 5, 2016: Journal of Plastic Surgery and Hand Surgery
N Paillocher, A S Florczak, M Richard, J M Classe, A S Oger, P Raro, R Wernert, G Lorimier
PURPOSE: The aim of the study was to evaluate morbidity and patient satisfaction following surgically treated skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) following mastectomy with neoadjuvant chemotherapy (NACT), and preoperative radiotherapy (RT), for operable invasive breast cancer. PATIENTS AND METHODS: This retrospective single-institution study included 111 patients who underwent a mastectomy with IBR after RT and/or NACT for invasive breast carcinoma at the Institut de Cancérologie de l'Ouest Paul Papin from January 1997 to January 2012...
July 2016: European Journal of Surgical Oncology
Tomoko Ogawa, Tomomi Yamakawa
INTRODUCTION: Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap...
2016: International Journal of Surgery Case Reports
C Garusi, A Manconi, G Lanni, G Lomeo, P Loschi, M C Simoncini, L Santoro, M Rietjens, J Y Petit
OBJECTIVES: The latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. MATERIALS AND METHODS: We retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011...
June 2016: Breast: Official Journal of the European Society of Mastology
Martine A van Huizum, Marije J Hoornweg, Noor de Ruiter, Erik Oudenhoven, J Joris Hage, Dirk Jan Veeger
OBJECTIVE: Dissection of the latissimus dorsi (LD) flap may have a distinct impact on upper extremity function and strength. To date, insufficient differentiation has been made between loss of muscular strength and shoulder function by dissection of the LD muscle per se and loss of function resulting from all excisional surgery, radiation therapy, and reconstructive procedures at the donor site and the recipient site that may have been combined near the shoulder region. METHODS: This study determines the long-term effect of the LD breast reconstruction on the strength profiles of the upper extremity by measuring the isometric torque strength both in seven synergistic- and two contra-movement directions...
August 2016: Journal of Plastic Surgery and Hand Surgery
Jiajun Feng, Cleone I Pardoe, Ashley Manuel Mota, Christopher Hoe Kong Chui, Bien-Keem Tan
BACKGROUND: The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant...
March 2016: Archives of Plastic Surgery
Martine A van Huizum, J Joris Hage, Emiel J Rutgers, Marije J Hoornweg
BACKGROUND: Local relapse after breast-conserving therapy including whole breast irradiation is typically treated by salvage mastectomy. Immediate reconstruction by pedicled transfer of a latissimus dorsi flap in combination with implantation of a definitive prosthesis or temporary tissue expander following skin sparing salvage mastectomy has been shown to be feasible. However, it has never been shown to be justifiable. AIM: The aim of the study was to compare the outcome of this procedure to the widely accepted secondary breast reconstruction by combined latissimus dorsi flap and implant after mastectomy and adjuvant radiotherapy...
August 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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