Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer.
BACKGROUND
The latissimus dorsi myocutaneous flap is frequently used for total breast reconstruction; however, few reports have been available regarding clinical outcome following conservative breast surgery. The aim of this study was to perform a retrospective review on 48 patients undergoing immediate latissimus dorsi myocutaneous flap surgery following conservative breast surgery between 1999 and 2004.


METHODS
Information on age, body mass index, smoking history, comorbid medical conditions, and oncologic status was collected. Reconstructed breast and donor-site complications were evaluated.


RESULTS
Mean follow-up was 16 months. In 56.2 percent of patients, tumors measured 2 cm or less (T1) and in 47.9 percent were located in the upper outer quadrants. Flap complications occurred in seven and donor-site complications occurred in 12 of 48 patients. Dorsal seroma (20.8 percent), dorsal dehiscence (6.2 percent), and partial flap loss (6.2 percent) were the most common complications. Surgical intervention with skin suture was necessary in two cases of dorsal wound dehiscence. Partial flap losses were limited and were treated by a conservative approach. A significant association (p = 0.035) was detected between dorsal seroma and obesity (body mass index or = 30 kg/m) and was associated with a 5.2-fold increase in the odds of developing this complication. No significant association between complications and age, smoking history, hypertension, diabetes, axillary lymph node dissection, or chemotherapy was found.


CONCLUSIONS
On the basis of our observations, the latissimus dorsi myocutaneous flap is a consistent technique for reconstruction following conservative breast surgery. Donor-site complications are more often observed in those who are obese; they are higher risk patients.
Munhoz
Alexandre Mendonça
AM
Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. alexandremunhoz@hotmail.com
Montag
Eduardo
E
Fels
Klaus Werner
KW
Arruda
Eduardo Gustavo P
EG
Sturtz
Gustavo P
GP
Aldrighi
Claudia
C
Gemperli
Rolf
R
Ferreira
Marcus Castro
MC
D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000601:surgery* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D016462:Mammaplasty; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps / Q000009:adverse effects