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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 Surgery
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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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Acknowledgements

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.

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    Authors and Affiliations

    1. Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China

      Chunjun Liu, Jie Luan, Yiye Ouyang, Yan Zhuang, Boyang Xu, Lin Chen, Shangshan Li, Su Fu & Minqiang Xin

    2. Beijing ALEO Clinic of Aesthetic Surgery, Beijing, China

      Yan Zhuang

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    1. Chunjun Liu
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    Correspondence to Chunjun Liu or Jie Luan.

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    The authors declare that they have no conflicts of interest to disclose.

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    The study has obtained IRB approval from the Ethical Committee of Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences.

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    Written informed consent was obtained from each patient prior to the study.

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    Dr. Chunjun Liu and Dr. Jie Luan contribute equally as co-corresponding author to this article.

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    Endoscopic video of harvesting LDM via transaxillary incision. (MP4 88408 kb)

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    Liu, C., Luan, J., Ouyang, Y. et al. Breast Reconstruction in Poland Syndrome Patients with Latissimus Dorsi Myo Flap and Implant: An Efficient Endoscopic Approach Using Single Transverse Axillary Incision. Aesth Plast Surg 43, 1186–1194 (2019). https://doi.org/10.1007/s00266-019-01346-0

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