Periareolar skin-sparing mastectomy and latissimus dorsi flap with biodimensional expander implant reconstruction: surgical planning, outcome, and complications.
BACKGROUND
Although use of the latissimus dorsi myocutaneous flap associated with the Biodimensional anatomical expander implant system (McGhan 150) is a reliable technique, little information has been available regarding clinical outcome following periareolar skin-sparing mastectomy reconstruction. The purpose of this study was to analyze the feasibility of the technique, surgical planning, and its outcome following skin-sparing mastectomy.


METHODS
Thirty-two patients underwent immediate unilateral latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system breast reconstruction. Mean follow-up was 18 months. The technique was indicated in patients with small- or moderate-volume breasts with or without ptosis, in whom the use of abdominal flaps was precluded. Flap and donor-site complications were evaluated. Information on anesthetic results and patient satisfaction was collected.


RESULTS
Seventy-two percent had tumors measuring 2 cm or less (T1) and 78 percent were stage 0 and I according to American Joint Committee on Cancer criteria. Breast skin complications occurred in 9.4 percent. Two patients presented small breast skin necrosis, and in one patient, a wound dehiscence was observed. Donor-site complications, all represented by seroma, occurred in 12.5 percent. The cosmetic result was considered good or very good in 84.4 percent, and the majority of patients were either very satisfied or satisfied. No local recurrences were observed. All complications except two were treated by conservative means.


CONCLUSIONS
The latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system is a simple and reliable technique for periareolar skin-sparing mastectomy reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative and postoperative management.
Munhoz
Alexandre Mendonça
AM
São Paulo, Brazil From the Division of Plastic Surgery; University of São Paulo School of Medicine.
Aldrighi
Claudia
C
Montag
Eduardo
E
Arruda
Eduardo Gustavo
EG
Aldrighi
José Mendes
JM
Filassi
José Roberto
JR
Ferreira
Marcus Castro
MC
D000328:Adult; D001938:Brazil; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D018579:Patient Selection; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D015625:Tissue Expansion Devices; D014945:Wound Healing / Q000502:physiology