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Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Mastectomy | Research

Useful vertical latissimus dorsi flap for partial breast reconstruction in every tumor location

Authors: Jong Ho Lee, Jeong Yeop Ryu, Kang Young Choi, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, Byungju Kang, Jeeyeon Lee, Ho Yong Park, Joon Seok Lee

Published in: BMC Surgery | Issue 1/2022

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Abstract

Background

We conducted a prospective cohort study to evaluate effective techniques for breast reconstruction after partial mastectomy due to breast cancer. Determining the method of reconstruction is often difficult as it depends on the location of the cancer and the amount of tissue excised.. Here, we present a new technique, using the vertical latissimus dorsi (LD) flap, that can be used in all partial mastectomies and can almost conceal scarring. We also compared these results to those of the mini LD flap.

Methods

We analyzed the data of a total of 50 and 47 patients, who underwent breast reconstruction with the mini LD flap and the vertical LD flap, respectively. Immediately after tumor excision, breast reconstruction was initiated. The skin flap for vertical LD was designed in a planarian shape, such that it may be hidden as much as possible and minimize bulging during closure, and the LD muscle flap was designed with a sufficient distance in the inferior direction.

Results

Our finding showed that the vertical LD flap group required significantly less total operation time than the mini LD flap group. While the mini-LD flap resulted in a scar that was difficult to conceal, the donor site scar of the vertical LD flap could not be seen easily, and no scar was visible on the back.

Conclusions

The vertical LD flap is useful for partial breast reconstruction, in all breast regions requires a rather small volume of the flap. Moreover, recovery was relatively fast with high patient satisfaction.
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Literature
1.
go back to reference Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRef Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRef
2.
go back to reference Lei S, Zheng R, Zhang S, et al. Global patterns of breast cancer incidence and mortality: a population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond). 2021;41:1183–94.CrossRef Lei S, Zheng R, Zhang S, et al. Global patterns of breast cancer incidence and mortality: a population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond). 2021;41:1183–94.CrossRef
3.
go back to reference Rainsbury RM, Paramanathan N. UK survey of partial mastectomy and reconstruction. Breast. 2007;16:637–45.CrossRef Rainsbury RM, Paramanathan N. UK survey of partial mastectomy and reconstruction. Breast. 2007;16:637–45.CrossRef
4.
go back to reference Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRef Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRef
5.
go back to reference Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRef Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRef
6.
go back to reference Huston TL, Simmons RM. Locally recurrent breast cancer after conservation therapy. Am J Surg. 2005;189:229–35.CrossRef Huston TL, Simmons RM. Locally recurrent breast cancer after conservation therapy. Am J Surg. 2005;189:229–35.CrossRef
7.
go back to reference Lee J, Jung JH, Kim WW, et al. Five-year oncologic outcomes of volume displacement procedures after partial mastectomy for breast cancer. Clin Breast Cancer. 2017;17:70–5.CrossRef Lee J, Jung JH, Kim WW, et al. Five-year oncologic outcomes of volume displacement procedures after partial mastectomy for breast cancer. Clin Breast Cancer. 2017;17:70–5.CrossRef
8.
go back to reference Yang JD, Lee JW, Cho YK, et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): Volume displacement. J Breast Cancer. 2012;15:1–6.CrossRef Yang JD, Lee JW, Cho YK, et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): Volume displacement. J Breast Cancer. 2012;15:1–6.CrossRef
9.
go back to reference Yang JD, Kim MC, Lee JW, et al. Usefulness of oncoplastic volume replacement techniques after breast conserving surgery in small to moderate-sized breasts. Arch Plast Surg. 2012;39:489–96.CrossRef Yang JD, Kim MC, Lee JW, et al. Usefulness of oncoplastic volume replacement techniques after breast conserving surgery in small to moderate-sized breasts. Arch Plast Surg. 2012;39:489–96.CrossRef
10.
go back to reference Audretsch WP, et al. Reconstruction of the partial mastectomy defect: classification and method. In: Spear SL, Willey SC, Robb GL, et al., editors. Surgery of the breast: principles and art. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 179–216. Audretsch WP, et al. Reconstruction of the partial mastectomy defect: classification and method. In: Spear SL, Willey SC, Robb GL, et al., editors. Surgery of the breast: principles and art. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 179–216.
11.
go back to reference Hamdi M, Van Landuyt K, et al. Pedicled perforator flaps. In: Spear SL, Willey SC, Robb GL, editors., et al., Surgery of the breast: principles and art. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 833–46. Hamdi M, Van Landuyt K, et al. Pedicled perforator flaps. In: Spear SL, Willey SC, Robb GL, editors., et al., Surgery of the breast: principles and art. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 833–46.
12.
go back to reference Masia J, Clavero JA, Larrañaga JR, et al. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg. 2006;59:594–9.CrossRef Masia J, Clavero JA, Larrañaga JR, et al. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg. 2006;59:594–9.CrossRef
13.
go back to reference Hamdi M, Van Landuyt K, de Frene B, et al. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg. 2006;59:644–52.CrossRef Hamdi M, Van Landuyt K, de Frene B, et al. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg. 2006;59:644–52.CrossRef
14.
go back to reference Hamdi M, Wolfli J, Van Landuyt K. Partial mastectomy reconstruction. Clin Plast Surg. 2007;34:51–62.CrossRef Hamdi M, Wolfli J, Van Landuyt K. Partial mastectomy reconstruction. Clin Plast Surg. 2007;34:51–62.CrossRef
15.
go back to reference Yang JD, Lee J, Lee JS, et al. Aesthetic scar-less mastectomy and breast reconstruction. J Breast Cancer. 2021;24:22–33.CrossRef Yang JD, Lee J, Lee JS, et al. Aesthetic scar-less mastectomy and breast reconstruction. J Breast Cancer. 2021;24:22–33.CrossRef
16.
go back to reference Elzawawy EM, Kelada MN, Al Karmouty AF. Design of mini latissimus dorsi flap based on thoracodorsal vascular patterns. Ann Plast Surg. 2018;80:607–15.CrossRef Elzawawy EM, Kelada MN, Al Karmouty AF. Design of mini latissimus dorsi flap based on thoracodorsal vascular patterns. Ann Plast Surg. 2018;80:607–15.CrossRef
17.
go back to reference Ribuffo D, Cigna E, Gerald GL, et al. Iginio Tansini revisited. Eur Rev Med Pharmacol Sci. 2015;19:2477–81.PubMed Ribuffo D, Cigna E, Gerald GL, et al. Iginio Tansini revisited. Eur Rev Med Pharmacol Sci. 2015;19:2477–81.PubMed
18.
19.
go back to reference Muhlbauer W, Olbrisch R. The latissimus dorsi myocutaneous flap for breast reconstruction. Chir Plast. 1977;4:27.CrossRef Muhlbauer W, Olbrisch R. The latissimus dorsi myocutaneous flap for breast reconstruction. Chir Plast. 1977;4:27.CrossRef
20.
go back to reference Chang DW, Youssef A, Cha S, et al. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg. 2002;110:751–9.CrossRef Chang DW, Youssef A, Cha S, et al. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg. 2002;110:751–9.CrossRef
21.
go back to reference Lee JS, Park E, Lee JH, et al. Alteration in skeletal posture between breast reconstruction with latissimus dorsi flap and mastectomy: A prospective comparison study. Gland Surg. 2021;10:1587–97.CrossRef Lee JS, Park E, Lee JH, et al. Alteration in skeletal posture between breast reconstruction with latissimus dorsi flap and mastectomy: A prospective comparison study. Gland Surg. 2021;10:1587–97.CrossRef
22.
go back to reference FS di Pompeo, G D'Orsi, G Firmani, et al. Total breast reconstruction with the fat-augmented latissimus dorsi (FALD) flap: high safety in a single-center uncontrolled case series. J Plast Reconstr Aesthet Surg. 2022 FS di Pompeo, G D'Orsi, G Firmani, et al. Total breast reconstruction with the fat-augmented latissimus dorsi (FALD) flap: high safety in a single-center uncontrolled case series. J Plast Reconstr Aesthet Surg. 2022
23.
go back to reference Lee J, Jung JH, Kim WW, et al. Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: a single center analysis. Surg Oncol. 2015;24(1):35–40.CrossRef Lee J, Jung JH, Kim WW, et al. Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: a single center analysis. Surg Oncol. 2015;24(1):35–40.CrossRef
24.
go back to reference Lee J, Jung JH, Kim WW, et al. Five-year oncologic outcomes of volume displacement procedures after partial mastectomy for breast cancer. Clin Breast Cancer. 2017;17(1):70–5.CrossRef Lee J, Jung JH, Kim WW, et al. Five-year oncologic outcomes of volume displacement procedures after partial mastectomy for breast cancer. Clin Breast Cancer. 2017;17(1):70–5.CrossRef
25.
go back to reference Lee J, Jung JH, Kim WW, et al. Comparison of 5-year oncological outcomes of breast cancer based on surgery type. ANZ J Surg. 2018;88(5):E395–9.CrossRef Lee J, Jung JH, Kim WW, et al. Comparison of 5-year oncological outcomes of breast cancer based on surgery type. ANZ J Surg. 2018;88(5):E395–9.CrossRef
26.
go back to reference Mericli AF, Szpalski C, Schaverien MV, et al. The latissimus dorsi myocutaneous flap is a safe and effective method of partial breast reconstruction in the setting of breast-conserving therapy. Plast Reconstr Surg. 2019;143:927e–35e.CrossRef Mericli AF, Szpalski C, Schaverien MV, et al. The latissimus dorsi myocutaneous flap is a safe and effective method of partial breast reconstruction in the setting of breast-conserving therapy. Plast Reconstr Surg. 2019;143:927e–35e.CrossRef
27.
go back to reference Youssif S, Hassan Y, Tohamy A, et al. Pedicled local flaps: a reliable reconstructive tool for partial breast defects. Gland Surg. 2019;8:527–36.CrossRef Youssif S, Hassan Y, Tohamy A, et al. Pedicled local flaps: a reliable reconstructive tool for partial breast defects. Gland Surg. 2019;8:527–36.CrossRef
28.
go back to reference Pignatti M, Tos P, Garusi C, et al. A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery. Injury. 2020;51(Suppl 4):S22–30.CrossRef Pignatti M, Tos P, Garusi C, et al. A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery. Injury. 2020;51(Suppl 4):S22–30.CrossRef
29.
go back to reference Cai R, Xie Z, Zhou L, et al. Pedicled descending branch latissimus dorsi mini-flap for repairing partial mastectomy defect: a new technique. Plast Reconstr Surg Glob Open. 2018;6: e1692.CrossRef Cai R, Xie Z, Zhou L, et al. Pedicled descending branch latissimus dorsi mini-flap for repairing partial mastectomy defect: a new technique. Plast Reconstr Surg Glob Open. 2018;6: e1692.CrossRef
30.
go back to reference Santanelli di Pompeo F, Laporta R, Sorotos M, Pagnoni M, Falesiedi F, Longo B. Latissimus dorsi flap for total autologous immediate breast reconstruction without implants. Plast Reconstr Surg 2014;134:871e-879e. Santanelli di Pompeo F, Laporta R, Sorotos M, Pagnoni M, Falesiedi F, Longo B. Latissimus dorsi flap for total autologous immediate breast reconstruction without implants. Plast Reconstr Surg 2014;134:871e-879e.
31.
go back to reference Economides JM, Song DH. Latissimus dorsi and immediate fat transfer (LIFT) for complete autologous breast reconstruction. Plast Reconstr Surg Glob Open. 2018;6: e1656.CrossRef Economides JM, Song DH. Latissimus dorsi and immediate fat transfer (LIFT) for complete autologous breast reconstruction. Plast Reconstr Surg Glob Open. 2018;6: e1656.CrossRef
32.
go back to reference Demiri EC, Dionyssiou DD, Tsimponis A, Goula CO, Pavlidis LC, Spyropoulou GA. Outcomes of fat-augmented latissimus dorsi (FALD) flap versus implant-based latissimus dorsi flap for delayed post-radiation breast reconstruction. Aesthetic Plast Surg. 2018;42:692–701.CrossRef Demiri EC, Dionyssiou DD, Tsimponis A, Goula CO, Pavlidis LC, Spyropoulou GA. Outcomes of fat-augmented latissimus dorsi (FALD) flap versus implant-based latissimus dorsi flap for delayed post-radiation breast reconstruction. Aesthetic Plast Surg. 2018;42:692–701.CrossRef
33.
go back to reference Lee JH, Ryu JY, Lee JH, et al. Simultaneous nipple reconstruction in autologous breast reconstruction. Gland Surg. 2021;10:2966–77. CrossRef Lee JH, Ryu JY, Lee JH, et al. Simultaneous nipple reconstruction in autologous breast reconstruction. Gland Surg. 2021;10:2966–77. CrossRef
34.
go back to reference Teo I, Whelehan P, Macaskill JE, Vinnicombe S, Munnoch DA, Evans A. Volpara™ as a measurement tool for breast volume. J Plast Reconstr Aesthet Surg. 2016;69(4):581–2.CrossRef Teo I, Whelehan P, Macaskill JE, Vinnicombe S, Munnoch DA, Evans A. Volpara™ as a measurement tool for breast volume. J Plast Reconstr Aesthet Surg. 2016;69(4):581–2.CrossRef
Metadata
Title
Useful vertical latissimus dorsi flap for partial breast reconstruction in every tumor location
Authors
Jong Ho Lee
Jeong Yeop Ryu
Kang Young Choi
Jung Dug Yang
Ho Yun Chung
Byung Chae Cho
Byungju Kang
Jeeyeon Lee
Ho Yong Park
Joon Seok Lee
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Mastectomy
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01741-6

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