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DOI: 10.5999/aps.2014.41.5.513
Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest
Background Currently, breast conservation therapy is commonly performed for the treatment of early breast cancer. Depending on the volume excised, patients may require volume replacement, even in cases of partial mastectomy. The use of the latissimus dorsi muscle is the standard method, but this procedure leaves an unfavorable scar on the donor site. We used an endoscope for latissimus dorsi harvesting to minimize the incision, thus reducing postoperative scars.
Methods Ten patients who underwent partial mastectomy and immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest were reviewed retrospectively. The total operation time, hospital stay, and complications were reviewed. Postoperative scarring, overall shape of the reconstructed breast, and donor site deformity were assessed using a 10-point scale.
Results In the mean follow-up of 11 weeks, no tumor recurrence was reported. The mean operation time was 294.5 (±38.2) minutes. The postoperative hospital stay was 11.4 days. Donor site seroma was reported in four cases and managed by office aspiration and compressive dressing. Postoperative scarring, donor site deformity, and the overall shape of the neobreast were acceptable, scoring above 7.
Conclusions Replacement of 20% to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap by using endoscopic harvesting is a good alternative reconstruction technique after partial mastectomy. Short incision benefits from a very acceptable postoperative scar, less pain, and early upper extremity movement.
This article was presented at the the 3rd Research and Reconstructive Forum on May 10, 2013, in Dagu, Korea
Publication History
Received: 02 April 2014
Accepted: 31 May 2014
Article published online:
05 May 2022
© 2014. 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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References
- 1 Fine NA, Schierle CF. Endoscopic approaches to the breast. In: Grotting JC, Neligan PC. Plastic surgery. 3rd ed. New York: Elsevier Saunders; 2013: 81-96
- 2 Losken A, Hamdi M. Partial breast reconstruction: current perspectives. Plast Reconstr Surg 2009; 124: 722-736
- 3 Pillarisetti RR, Querci Della Rovere G. Oncoplastic breast surgery. Indian J Surg 2012; 74: 255-263
- 4 Park HS, Lee JS, Lee JS. et al. The feasibility of endoscopy-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer 2011; 14: 52-57
- 5 Missana MC, Pomel C. Endoscopic latissimus dorsi flap harvesting. Am J Surg 2007; 194: 164-169
- 6 Adams Jr WP, Lipschitz AH, Ansari M. et al. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg 2004; 53: 6-11
- 7 Cho BC, Lee JH, Ramasastry SS. et al. Free latissimus dorsi muscle transfer using an endoscopic technique. Ann Plast Surg 1997; 38: 586-593
- 8 Tan O, Aydin OE, Cinal H. et al. Latissimus dorsi flap harvest with a short incision. Microsurgery 2013; 33: 203-206
- 9 Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg 2012; 129: 1305-1312
- 10 Rainsbury RM, Paramanathan N. UK survey of partial mastectomy and reconstruction. Breast 2007; 16: 637-645
- 11 Fisher B, Redmond C, Poisson R. et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989; 320: 822-828
- 12 Losken A. The oncoplastic approach to partial breast reconstruction. In: Grotting JC, Neligan PC. Plastic surgery. 3rd ed. New York: Elsevier Saunders; 2013: 296-313
- 13 Boetes C, Mus RD, Holland R. et al. Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 1995; 197: 743-747
- 14 Brierley JD, Paterson IC, Lallemand RC. et al. The influence of breast size on late radiation reaction following excision and radiotherapy for early breast cancer. Clin Oncol (R Coll Radiol) 1991; 3: 6-9
- 15 Cross MA, Elson HR, Aron BS. Breast conservation radiation therapy technique for women with large breasts. Int J Radiat Oncol Biol Phys 1989; 17: 199-203
- 16 Friedlander L, Sundin J. Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg 1994; 94: 881-884
- 17 Fine NA, Orgill DP, Pribaz JJ. Early clinical experience in endoscopic-assisted muscle flap harvest. Ann Plast Surg 1994; 33: 465-469
- 18 Szychta P, Butterworth M, Dixon M. et al. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap. Breast 2013; 22: 667-672
- 19 Cha W, Jeong WJ, Ahn SH. Latissimus dorsi muscle free flap revisited: a novel endoscope-assisted approach. Laryngoscope 2013; 123: 613-617
- 20 Guven E, Basaran K, Yazar M. et al. Electrothermal bipolar vessel sealer in endoscope-assisted latissumus dorsi flap harvesting. J Laparoendosc Adv Surg Tech A 2010; 20: 735-742
- 21 Lin CH, Wei FC, Levin LS. et al. Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 1999; 104: 1070-1077
- 22 Karp NS, Bass LS, Kasabian AK. et al. Balloon assisted endoscopic harvest of the latissimus dorsi muscle. Plast Reconstr Surg 1997; 100: 1161-1167