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European Journal of Plastic Surgery

, Volume 36, Issue 10, pp 627–632 | Cite as

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

  • Joaquim Muñoz i Vidal
  • Tiago A. Gomes RodriguesEmail author
  • Cristian Carrasco Lopez
  • Anna B. Lopez Ojeda
  • Felix Angel Chavarria Marín
  • Josep M. Serra Payro
  • Juan Maria Viñals Viñals
Original Paper

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.

Keywords

Endoscopic plastic surgery Endoscopically latissimus dorsi Scarless breast reconstruction 

Notes

Conflicts of Interest

None.

Supplementary material

ESM 1

WMV 21,669 kb

References

  1. 1.
    Jahkola T, Asko-S S, von Smitten K (2003) Immediate breast reconstruction. Scand J Surg 92(4):249–256PubMedGoogle Scholar
  2. 2.
    Losken A, Schaefer TG, Carlson GW, Jones GE (2004) Immediate endoscopic latissimus dorsi flap risk or benefit in reconstructing partial mastectomy defects. Ann Plast Surg 53(1):1–5PubMedCrossRefGoogle Scholar
  3. 3.
    Lin C, Wei FC, Levin SL et al (1999) Donor site morbidity comparision between endoscopically assisted and traditional harvest for free latissimus dorsi flap. Plast Reconstr Surg 104:1070–1078PubMedGoogle Scholar
  4. 4.
    Friedlander L, Sundin J (1993) Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg 94:881–884Google Scholar
  5. 5.
    Fine NA, Orgill DP, Pribaz JJ (1994) Early clinical experience in endoscopic assisted muscle flap harvest. Ann Plast Surg 33:465–472PubMedCrossRefGoogle Scholar
  6. 6.
    Bostwick J III (1999) Plastic reconstructive breast surgery, 2nd edn. Quality Medical Publishing, St. LouisGoogle Scholar
  7. 7.
    Missana MC, Pomel C (2007) Endoscopic latissimus dorsi flap harvesting. Am J Surg 194:164–169PubMedCrossRefGoogle Scholar
  8. 8.
    Rainsbury R, Paramanthan N (1998) Recent progress in breast conserving volume replacement using latissimus dorsi mini flaps in U.K. patient. Breast Cancer 5:139–147PubMedCrossRefGoogle Scholar
  9. 9.
    Monticciolo DL, Ross D, Bostwick J III et al (1996) Autologous breast reconstruction with endoscopic latissimus dorsi musculosubcutaneous flaps in patients choosing breast-conserving therapy: mammographic appearance. Am J Roentgenol 167:385–389CrossRefGoogle Scholar
  10. 10.
    Fine NA, Orgill DP, Privaz JJ (1994) Early clinical experience in endoscopic assisted muscle flap harvest. Ann Plast Surg 33:465–469PubMedCrossRefGoogle Scholar
  11. 11.
    Pomel C, Missana MC (2003) Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol 29:127–231PubMedCrossRefGoogle Scholar
  12. 12.
    Pomel C, Missana MC, Lasser P (2002) Prélèvement endoscopique d’un lambeau musculaire pur de grand dorsal en reconstruction mammaire. Étude de faisabilité et revue de la littérature. Ann Chir 127:337–342PubMedCrossRefGoogle Scholar
  13. 13.
    Glassey N, Perks GB, McCulley SJ (2008) A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction. Plast Reconstr Surg 122:1334–1340PubMedCrossRefGoogle Scholar
  14. 14.
    Stenberg EG, Perdikis G, Mc Laughlin SA et al (2000) Latissimus dorsi flap remains an excellent choice for breast reconstruction. Ann Plast Surg 56:31–35CrossRefGoogle Scholar
  15. 15.
    Freeman ME, Perdikis G, Stenberg EG, TerKonda SP, Waldorf JC (2006) Latissimus dorsi reconstruction: a good option for patients with failed breast conservation therapy. Ann Plast Surg 57:134–137PubMedCrossRefGoogle Scholar
  16. 16.
    Lopez Ojeda AB, Carrasco Lopez C, Gomes Rodrigues TA, Muñoz Vidal J et al (2012) Thoracodorsal artery perforator (TDAP) flap in immediate breast reconstruction and the role of preoperative mapping:a clinical experience. Eur J Plast Surg. doi: 10.1007/s00238-012-0769-0 Google Scholar
  17. 17.
    Halperin TJ, Fox SE, Caterson SA (2007) Delayed division of the thoracodorsal nerve: a useful adjunct in breast reconstruction. Ann Plast Surg 59(1):23–25PubMedCrossRefGoogle Scholar
  18. 18.
    Cho BC, Lee JH, Ramasastry SS et al (1995) Free Latissimus dorsi muscle transfer using endoscopic techniques. Ann Plast Surg 38:586–593CrossRefGoogle Scholar
  19. 19.
    Van Buskirk ER, Rehnke RD, Montgomery RL et al (1997) Endoscopic harvest of the latissimus dorsi muscle using the balloon dissection technique. Plast Reconstr Surg 99:899–903PubMedCrossRefGoogle Scholar
  20. 20.
    Karp NS, Bass LS, Kasabian AK et al (1997) Balloon assisted endoscopic harvest of the latissimus dorsi muscle. Plast Reconstr Surg 100:1061–1167CrossRefGoogle Scholar
  21. 21.
    Shwabegger A, Ninkovic M, Brenner E et al (1997) Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap; observation on cause and prevention. Ann Plast Surg 38:594–597CrossRefGoogle Scholar
  22. 22.
    Tomita K, Yano K, Masuoka T et al (2007) Postoperative seroma formation in breast reconstruction with latissimus dorsi flaps; a restrospective study of 174 consecutive cases. Ann Plast Surg 59:149–151PubMedCrossRefGoogle Scholar
  23. 23.
    Randolph LC, Barone J, Angelats J, Dado DV, Vandevender DK, Shoup M (2005) Prediction of postoperative seroma after latissimus dorsi breast reconstruction. Plast Reconstr Surg 5:1287–1290Google Scholar
  24. 24.
    Jeon B-J, Lee T-S, Lim S-Y et al (2012) Risk factors for donor-site seroma formation after immediate breast reconstruction with the extended latissimus dorsi flap. Ann Plast Surg 69:145–147PubMedCrossRefGoogle Scholar
  25. 25.
    Jain PK, Sowdi R, Anderson A, Macfie J (2004) Randomized clinical trial investigating the use of drains and fibrin sealant following surgery for breast cancer. Br J Surg 91:54–60PubMedCrossRefGoogle Scholar
  26. 26.
    Carless PA, Henry DA (2006) Systematic review and metaanalysis of the use of fibrin sealant to prevent seroma formation after breast cancer surgery. Br J Surg 93:810–819PubMedCrossRefGoogle Scholar
  27. 27.
    Daltrey I, Thomson H, Hussien M, Krishna K, Rayter Z, Winters ZE (2006) Randomised clinical trial of the effect of quilting latissimus dorsi flap donor site on seroma formation. Br J Surg 93:825–830PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Joaquim Muñoz i Vidal
    • 1
  • Tiago A. Gomes Rodrigues
    • 1
    Email author
  • Cristian Carrasco Lopez
    • 1
  • Anna B. Lopez Ojeda
    • 1
  • Felix Angel Chavarria Marín
    • 1
  • Josep M. Serra Payro
    • 1
  • Juan Maria Viñals Viñals
    • 1
  1. 1.Plastic Surgery DepartmentBellvitge HospitalBarcelonaSpain

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