Abstract
Background
The design of the latissimus dorsi musculocutaneous flap in breast reconstruction has several options. To date, there have been no reports on the surgical outcomes with flap designed based on the defect shape of the mastectomy site and flap shape of the donor site. To compare patient satisfaction according to the flap design, we designed and conducted independent three sub-studies targeting fifty-three breast reconstruction patients using BREAST-Q© scale.
Methods
In study 1, there was no difference in patient satisfaction between the group with the flap designed according to the shape of mastectomy defect (defect-oriented group) that with the flap designed according to patient's wish regardless of defect shape (back scar-oriented group). In study 2, comparing the results based on the shape of the flap, vertically designed flap showed a statistically significant difference in the psychosocial well-being. In study 3, comparing the results based on the shape of the defect, no significant difference was noted.
Results
Even though designing a donor flap based on the shape and orientation of the mastectomy defect has no statistical significance in patient satisfaction or quality of life compared with that based on the patient preference in placement of the donor site scar, the group with the vertical donor design showed better psychosocial well-being than the group with other shapes of the donor flap. By considering the advantages and disadvantages of each flap design, enhanced patient satisfaction and durability and natural aesthetic goal can be achieved.
-
This is the first study to compare the differences in results according to the flap design method during breast reconstruction.
-
Patient satisfaction according to the design of the flap was investigated in the form of a questionnaire survey, and the results were displayed.
-
In addition to breast shape, donor scars and complications were also investigated.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
McCraw JB, Papp C, Edwards A, McMellin A (1994) The autogenous latissimus breast reconstruction. Clin Plast Surg 21:279–288
Hokin JA, Silfverskiold KL (1987) Breast reconstruction without an implant: results and complications using an extended latissimus dorsi flap. Plast Reconstr Surg 79:58–66
Papp C, McCraw JB (1998) Autogenous latissimus breast reconstruction. Clin Plast Surg 25:261–266
McCraw JB, Papp C (1991) Latissimus dorsi myocutaneous flap: “fleur de lis” reconstruction. In: Hartrampf CR (ed) Hartrampf’s breast reconstruction with living tissue. Hampton Press, Norfolk, p 221
Aitken ME, Mustoe TA (2002) Why change a good thing? Revisiting the fleur-de-lis reconstruction of the breast. Plast Reconstr Surg 109:525–533
Ruetschi MS, LeWinn LR, Chaglassian TA (1981) Variation of latissimus dorsi skin island design for postmastectomy reconstruction. Ann Plast Surg 6:171–178
Millard DR Jr (1981) Variations in the design of the latissimus dorsi flap in breast reconstruction. Ann Plast Surg 7:269–271
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 126:358–365
Chang DW, Youssef A, Cha S, Reece GP (2002) Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 110:751–759
Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ (2009) Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 124:345–353
Klassen AF, Pusic AL, Scott A, Klok J, Cano SJ (2009) Satisfaction and quality of life in women who undergo breast surgery: a qualitative study. BMC Womens Health 9:11
Albornoz CR, Bach PB, Mehrara BJ, Disa JJ, Pusic AL, McCarthy CM, Cordeiro PG, Matros E (2013) A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg 131:15–23
Jagsi R, Li Y, Morrow M, Janz N, Alderman A, Graff J, Hamilton A, Katz S, Hawley S (2015) Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors. Ann Surg 261:1198–1206
Durkin AJ, Pierpont YN, Patel S, Tavana ML, Uberti MG, Payne WG, Smith DJ, Smith PD (2010) An algorithmic approach to breast reconstruction using latissimus dorsi myocutaneous flaps. Plast Reconstr Surg 125:1318–1327
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare they have no conflicts of interest.
Informed Consent
For this type of study formal consent is not required. However, informed consent was obtained for the use of their images.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rha, E.Y., Jeon, H.H., Park, S.H. et al. Defect-Oriented Versus Back Scar-Oriented Flap Design in Breast Reconstruction with Latissimus Dorsi Musculocutaneous Flap: A Patient-Reported Satisfaction Outcome Comparison Using BREAST-Q. Aesth Plast Surg 48, 259–265 (2024). https://doi.org/10.1007/s00266-023-03385-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-023-03385-0