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Endoscopically harvested latissimus dorsi: a scarless technique in immediate partial breast reconstruction

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Abstract

Background

Harvesting the latissimus dorsi muscle flap endoscopically is a well-known and well-documented technique, though it is still not widespread in clinical practice. This approach provides autologous tissue for the oncological resection bed, creating the most favorable conditions for subsequent radiotherapy. The endoscopic approach minimizes scarring at the donor site.

Methods

Between September 2010 and November 2012, a total of 29 patients were operated on for breast cancer and immediately reconstructed using a latissimus dorsi muscle flap obtained endoscopically. In all cases, the tumor location was the upper and outer pole of the breast. In this paper, we present the results obtained in 19 patients operated on between September 2010 and November 2011 with a minimum follow-up of 12 months after surgery and at least 6 months after adjuvant radiotherapy. The filling volume obtained with the transposition of the flap was studied using magnetic resonance imaging within 6 months postradiotherapy.

Results

The mean hospital stay was 3 days. In all cases, suction drains in the breast and the donor site were removed within 8 days. No surgical revision was required. No necrosis was documented in any of the flaps. Minimal to moderate seroma was documented in nine cases (48 %). MRI studies revealed degenerative changes of the muscle fibers but which did not affect final breast volume because 30 % more muscle than necessary had been recruited. When interviewed a year after the intervention, none of the patients reported changes in the type of bra cup.

Conclusions

The use of the latissimus dorsi muscle flap obtained endoscopically is a highly effective technique in the reconstruction of partial breast defects immediately after cancer surgery. It is particularly useful when the tumor is located in the upper or outer quadrants. The endoscopic approach offers less associated scarring than the classical technique and minimal anatomical variability compared with the use of thoracodorsal artery perforator flaps.

Level of evidence: Level IV, therapeutic study.

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Conflicts of Interest

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Correspondence to Tiago A. Gomes Rodrigues.

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Muñoz i Vidal, J., Gomes Rodrigues, T.A., Carrasco Lopez, C. et al. Endoscopically harvested latissimus dorsi: a scarless technique in immediate partial breast reconstruction. Eur J Plast Surg 36, 627–632 (2013). https://doi.org/10.1007/s00238-013-0842-3

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Keywords

  • Endoscopic plastic surgery
  • Endoscopically latissimus dorsi
  • Scarless breast reconstruction