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CC BY-NC 4.0 · Arch Plast Surg 2016; 43(02): 197-203
DOI: 10.5999/aps.2016.43.2.197
Original Article

Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

Jiajun Feng
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Cleone I Pardoe
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
,
Ashley Manuel Mota
Hull and East Yorkshire Trust, England, Yorkshire, UK
,
Christopher Hoe Kong Chui
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Bien-Keem Tan
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant.

Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant.

Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry.

Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

Keywords

Breast - Reconstructive surgical procedures - Tissue expansion - Surgical flaps - Radiotherapy

We thank Mr. Evan Lim for the medical illustration.




Publication History

Received: 29 July 2015

Accepted: 05 November 2015

Article published online:
20 April 2022

© 2016. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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