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Fat Compartments of the Back and Their Clinical Applications to Breast Reconstruction Using the Low Transverse Extended Latissimus Dorsi Flap

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Breast Reconstruction

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Abstract

Introduction: The use of the extended latissimus dorsi flap remains limited in autologous breast reconstruction because of insufficient volume and donor-site morbidity. Use of the low transverse extended latissimus dorsi flap harvest technique increases flap volumes and improves donor-site aesthetics. The skin paddle is oriented transversely over the lumbothoracic and lumbar fat compartment, which allows for efficient harvest of the largest fat depots in the back. The low transverse extended latissimus dorsi flap is based on the descending branch of the thoracodorsal artery but differs in other approaches to extended harvest techniques by centering the flap over the fat compartments with the most volume. In addition, the supplementary fat harvest is confined to the lower back preventing the unsightly upper back contour deformity. The low transverse skin paddle extended latissimus dorsi flap is reliable and a viable option to provide ample volume for completely autologous breast reconstruction for a select group of patients.

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References

  1. Bostwick JI, Nahai F, Wallace JG, Vasconez LO (1979) Sixty latissimus dorsi flaps. Plast Reconstr Surg 63(1):31–41

    Article  PubMed  Google Scholar 

  2. Mathes SJ, Nahai F (1981) Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 67(2):177–187

    Article  PubMed  CAS  Google Scholar 

  3. Schaverien M, Wong C, Bailey S, Saint-Cyr M (2010) Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap – anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg 63(12):2123–2127

    Article  PubMed  Google Scholar 

  4. Bartlett SP, May JW Jr, Yaremchuk MJ (1981) The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg 67(5):631–636

    Article  PubMed  CAS  Google Scholar 

  5. Tansini I (1906) Sopra il mio nuovo processo di amputazione della mammella. Gazz Med Ital 57:141

    Google Scholar 

  6. Maxwell GP (1980) Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 65(5):686–692

    Article  PubMed  CAS  Google Scholar 

  7. Vyas RM, Dickinson BP, Fastekjian JH, Watson JP, Dalio AL, Crisera CA (2008) Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg 121(5):1519–1526

    Article  PubMed  CAS  Google Scholar 

  8. Spear SL, Ducic I, Cuoco F, Taylor N (2007) Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction. Plast Reconstr Surg 119(3):788–795

    Article  PubMed  CAS  Google Scholar 

  9. Hammond DC (2009) Latissimus dorsi flap breast reconstruction. Clin Plast Surg 34(1):75–82

    Article  Google Scholar 

  10. Chang DW, Barnea Y, Robb GL (2008) Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts. Plast Reconstr Surg 122(2):356–362

    Article  PubMed  CAS  Google Scholar 

  11. Pinsolle V, Grinfeder C, Mathoulin-Pelissier S, Faucher A (2006) Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg 59(10):1017–1024

    Article  PubMed  Google Scholar 

  12. Spear SL, Boehmler JH, Taylor NS, Prada C (2007) The role of the latissimus dorsi flap in reconstruction of the irradiated breast. Plast Reconstr Surg 119(1):1–9

    Article  PubMed  Google Scholar 

  13. McCraw JB, Maxwell GP, Horton CE (1980) Reconstruction of the breast following mastectomy. Acta Chir Belg 79(2):131–133

    PubMed  CAS  Google Scholar 

  14. Tarantino I, Banic A, Fischer T (2006) Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg 117(5):1387–1394

    Article  PubMed  CAS  Google Scholar 

  15. Spear SL, Newman MK, Bedford MS, Schwartz KA, Cohen M, Schwartz JS (2008) A retrospective analysis of outcomes using three common methods for immediate breast reconstruction. Plast Reconstr Surg 122(2):340–347

    Article  PubMed  CAS  Google Scholar 

  16. Sakai S, Ando K, Natori M (2005) Cosmetic reconstruction after resection of breast cancer: use of the ELD-MC flap and EVRAM flap. Int J Clin Oncol 10(5):298–303

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Germann G, Steinau HU (1996) Breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 97(3):519–526

    Article  PubMed  CAS  Google Scholar 

  19. Denewer A, Setit A, Hussein O, Farouk O (2008) Skin-sparing mastectomy with immediate breast reconstruction by a new modification of extended latissimus dorsi myocutaneous flap. World J Surg 32(12):2586–2592

    Article  PubMed  Google Scholar 

  20. Chang DW, Youssef A, Cha S, Reece GP (2002) Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 110(3):751–759

    Article  PubMed  Google Scholar 

  21. Papp C, McCraw JB (1998) Autogenous latissimus breast reconstruction. Clin Plast Surg 25(2):261–266

    PubMed  CAS  Google Scholar 

  22. Delay E, Gounot N, Bouillot A, Zlatoff P, Rivoire M (1998) Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients. Plast Reconstr Surg 102(5):1461–1478

    Article  PubMed  CAS  Google Scholar 

  23. Clough KB, Louis-Sylvestre C, Fitoussi A, Couturaud B, Nos C (2002) Donor site sequelae after autologous breast reconstruction with an extended latissimus dorsi flap. Plast Reconstr Surg 109(6):1904–1911

    Article  PubMed  Google Scholar 

  24. Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119(7):2219–2227

    Article  PubMed  CAS  Google Scholar 

  25. Rohrich RJ, Pessa JE (2008) The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 121(5):1804–1809

    Article  PubMed  CAS  Google Scholar 

  26. Rohrich RJ, Pessa JE, Ristow B (2008) The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg 121(6):2107–2112

    Article  PubMed  CAS  Google Scholar 

  27. Hatef DA, Hollier LH Jr (2009) Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 124(1):315–316

    Article  PubMed  CAS  Google Scholar 

  28. Schaverien MV, Pessa JE, Rohrich RJ (2009) Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 123(2):695–700

    Article  PubMed  CAS  Google Scholar 

  29. Bailey SH, Saint-Cyr M, Oni G, Wong C, Maia M, Nguyen V, Pessa JE, Colohan S, Rohrich RJ, Mojallal A (2011) The low transverse extended latissimus dorsi flap based on fat compartments of the back for breast reconstruction: anatomical study and clinical results. Plast Reconstr Surg 128(5):382e–394e

    Article  PubMed  Google Scholar 

  30. Bailey S, Saint-Cyr M, Zhang K, Mojallal A, Wong C, Ouyang D, Maia M, Zhang S, Rohrich RJ (2010) Breast reconstruction with the latissimus dorsi flap: women’s preference for scar location. Plast Reconstr Surg 126(2):358–365

    Article  PubMed  CAS  Google Scholar 

  31. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 124(5):1529–1544

    Article  PubMed  CAS  Google Scholar 

  32. Bailey SH, Oni G, Guevara R, Wong C, Saint-Cyr M (2012) Latissimus dorsi donor-site morbidity: the combination of quilting and fibrin sealant reduce length of drain placement and seroma rate. Ann Plast Surg 68(6):555–558

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, 1801 Inwood Rd. 4th Floor, Dallas, TX, 75390-9132, USA

    Steven H. Bailey M.D.

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  1. Steven H. Bailey M.D.
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Correspondence to Steven H. Bailey M.D. .

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Editors and Affiliations

  1. Tustin, California, USA

    Melvin A. Shiffman

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© 2016 Springer International Publishing Switzerland

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Bailey, S.H. (2016). Fat Compartments of the Back and Their Clinical Applications to Breast Reconstruction Using the Low Transverse Extended Latissimus Dorsi Flap. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_67

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  • DOI: https://doi.org/10.1007/978-3-319-18726-6_67

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18725-9

  • Online ISBN: 978-3-319-18726-6

  • eBook Packages: MedicineMedicine (R0)

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