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Outcomes of Fat-Augmented Latissimus Dorsi (FALD) Flap Versus Implant-Based Latissimus Dorsi Flap for Delayed Post-radiation Breast Reconstruction

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  • Breast Surgery
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Abstract

Background

Although free abdominal flaps constitute the gold standard in post-radiation delayed breast reconstruction, latissimus dorsi-based methods offer alternative reconstructive options. This retrospective study aims to compare outcomes of delayed breast reconstruction using the fat-augmented latissimus dorsi (FALD) autologous reconstruction and the latissimus dorsi-plus-implant reconstruction in irradiated women.

Methods

We reviewed the files of 47 post-mastectomy irradiated patients (aged 29–73 years), who underwent delayed latissimus dorsi-based breast reconstruction between 2010 and 2016. Twenty-three patients (Group A) had an extended FALD flap and twenty-four patients (Group B) an implant-based latissimus dorsi reconstruction. Patients’ age, BMI, pregnancies, volume of injected fat, implant size, postoperative complications, and secondary surgical procedures were recorded and analyzed.

Results

Age, BMI, pregnancies, and donor-site complications were similar in both groups (p > 0.05). Mean fat volume injected initially was 254 cc (ranged 130–380 cc/session); mean implant volume was 323 cc (ranged 225–420 cc). Breast complications were significantly fewer in Group A (one wound dehiscence, two oily cysts) compared to Group B (three cases with wound dehiscence, two extrusions, thirteen severe capsular contractions). Non-statistically significant difference was documented for secondary procedures between groups; although the mean number of additional surgeries/patient was higher in Group A, they referred to secondary lipofilling, whereas in Group B they were revision surgeries for complications.

Conclusions

The FALD flap constitutes an alternative method for delayed autologous reconstruction after post-mastectomy irradiation, avoiding implant-related complications. Although additional fat graft sessions might be required, it provides an ideal autogenous reconstructive option for thin nulliparous women, with a small opposite breast and adequate fat donor sites.

Level of Evidence IV

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Authors and Affiliations

  1. Department of Plastic Surgery, Medical School, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Efterpi C. Demiri, Dimitrios D. Dionyssiou, Antonios Tsimponis, Christina-Olga Goula, Leonidas C. Pavlidis & Georgia-Alexandra Spyropoulou

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  1. Efterpi C. Demiri
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  2. Dimitrios D. Dionyssiou
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  3. Antonios Tsimponis
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  4. Christina-Olga Goula
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  5. Leonidas C. Pavlidis
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  6. Georgia-Alexandra Spyropoulou
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Correspondence to Efterpi C. Demiri.

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Demiri, E.C., Dionyssiou, D.D., Tsimponis, A. et al. Outcomes of Fat-Augmented Latissimus Dorsi (FALD) Flap Versus Implant-Based Latissimus Dorsi Flap for Delayed Post-radiation Breast Reconstruction. Aesth Plast Surg 42, 692–701 (2018). https://doi.org/10.1007/s00266-018-1081-6

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  • DOI: https://doi.org/10.1007/s00266-018-1081-6

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