Breast Reconstruction in Poland Syndrome Patients with Latissimus Dorsi Myo Flap and Implant: An Efficient Endoscopic Approach Using Single Transverse Axillary Incision
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Breast hypoplasia or amastia with pectoralis major muscle defect in female Poland syndrome patients always necessitates surgical intervention. This study aims to introduce an efficient endoscopic technique to perform breast reconstruction in Poland syndrome patients with a latissimus dorsi myo flap and an implant using a single transverse axillary incision (ELDM + IMPLANT) and to evaluate its safety and effectiveness.
A prospective study was designed to recruit Poland syndrome candidates for ELDM + IMPLANT breast reconstruction. Only one transaxillary incision was made to harvest the LDM flap and create the anterior chest wall pocket. The LDM flap was transposed to the front to reconstruct the breast with a silicone implant. Patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time and post-operative complications were collected. The BREAST-Q reconstruction module was used to evaluate patient quality of life. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities.
Sixteen eligible patients were recruited and received ELDM + IMPLANT-BR. Mean endoscopic time for LDM flap harvesting was 61.6 min. All of the 16 patients recovered uneventfully without any significant complications. The post-operative scores of satisfaction with breast and psychosocial well-being were significantly higher than the pre-operative ones. The score of DASH was 7.1 pre-operatively and 8.3 post-operatively with no significant difference either. The score of satisfaction with outcome was 80.0.
Our proposed ELDM + IMPLANT technique provides a safe and efficient way to reconstruct breasts in Poland syndrome patients with a high satisfaction rate, optimized aesthetic outcome and minimized donor site morbidity.
Level of Evidence IV
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KeywordsPoland syndrome Latissimus dorsi myo flap Breast reconstruction Endoscope
This study was supported by Captital’s Funds for Health Improvement and Research 2016-2-4041, PUMC Youth Fund & the Fundamental Research Funds for the Central Universities 3332015156, to Dr. Chunjun Liu, and CAMS Initiative for Innovative Medicine (CAMS-I2M) (2017-I2M-3-006) to Dr. Jie Luan.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Human and Animal Rights or Ethical Approval
The study has obtained IRB approval from the Ethical Committee of Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences.
Written informed consent was obtained from each patient prior to the study.
Endoscopic video of harvesting LDM via transaxillary incision. (MP4 88408 kb)
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