TY - JOUR
T1 - Esthetic outcome of immediate reconstruction with latissimus dorsi myocutaneous flap after breast-conservative surgery and skin-sparing mastectomy
AU - Tomita, Koichi
AU - Yano, Kenji
AU - Matsuda, Ken
AU - Takada, Akiyoshi
AU - Hosokawa, Ko
PY - 2008/7
Y1 - 2008/7
N2 - With the recent advances in oncologic breast surgery, breast reconstruction with the latissimus dorsi myocutaneous (LDM) flap without an implant has become a good option among other autologous tissue reconstructions available. However, only a few large-scale studies have so far evaluated the critical factors affecting its esthetic outcomes. We retrospectively reviewed 97 consecutive patients who underwent breast reconstruction with the LDM flap between 2001 and 2005 at our institution. The esthetic outcome in comparison with the normal breast was evaluated by means of observer assessment consisting of 7 criteria. A stratified analysis was performed to determine the factors affecting the esthetic outcomes after the breast-conservative surgery and skin-sparing mastectomy. We found that reconstruction of the lower half of the breast and exposure of the skin paddle resulted in poor esthetic outcomes after breast-conservative surgery. Large preoperative brassiere cup size, radiation history, axillary node dissection, and exposure of the skin paddle were the factors which negatively affected the overall outcomes after skin-sparing mastectomy. Age, body mass index, presence of nipple areola-complex defect, or design of skin paddle did not affect the esthetic outcomes. On the basis of these critical factors, we could determine the indications and limitations of breast reconstruction with LDM flap. In some cases, further technical modifications are still warranted, and we believe that these modifications will optimize the use of this flap in breast reconstruction.
AB - With the recent advances in oncologic breast surgery, breast reconstruction with the latissimus dorsi myocutaneous (LDM) flap without an implant has become a good option among other autologous tissue reconstructions available. However, only a few large-scale studies have so far evaluated the critical factors affecting its esthetic outcomes. We retrospectively reviewed 97 consecutive patients who underwent breast reconstruction with the LDM flap between 2001 and 2005 at our institution. The esthetic outcome in comparison with the normal breast was evaluated by means of observer assessment consisting of 7 criteria. A stratified analysis was performed to determine the factors affecting the esthetic outcomes after the breast-conservative surgery and skin-sparing mastectomy. We found that reconstruction of the lower half of the breast and exposure of the skin paddle resulted in poor esthetic outcomes after breast-conservative surgery. Large preoperative brassiere cup size, radiation history, axillary node dissection, and exposure of the skin paddle were the factors which negatively affected the overall outcomes after skin-sparing mastectomy. Age, body mass index, presence of nipple areola-complex defect, or design of skin paddle did not affect the esthetic outcomes. On the basis of these critical factors, we could determine the indications and limitations of breast reconstruction with LDM flap. In some cases, further technical modifications are still warranted, and we believe that these modifications will optimize the use of this flap in breast reconstruction.
KW - Breast conservative surgery
KW - Breast reconstruction
KW - Esthetic outcome
KW - Latissimus dorsi myocutaneous flap
KW - Skin sparing mastectomy
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U2 - 10.1097/SAP.0b013e318156a1cf
DO - 10.1097/SAP.0b013e318156a1cf
M3 - Article
C2 - 18580144
AN - SCOPUS:48149092484
VL - 61
SP - 19
EP - 23
JO - Annals of Plastic Surgery
JF - Annals of Plastic Surgery
SN - 0148-7043
IS - 1
ER -