title: Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap.
abstract: OBJECTIVE
  To analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction.
  
  
  METHODS
  Prospective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months.
  
  
  RESULTS
  The reconstructed and healthy breasts decreased in volume in group 1 (-45.85 cm(3) ± 48.41 cm(3), p = 0.0004; -29.13 cm(3) ± 14.98 cm(3), p = 0.0009) and in group 2 (-31.5 cm(3) ± 25.35 cm(3), p = 0.0001; -15.4 cm(3) ± 21.96 cm(3), p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05). Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p < 0.0001), animation (p < 0.0001) and higher scores for the overall satisfaction about the reconstructed breast (p = 0.0001).
  
  
  CONCLUSIONS
  We suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast.
authors: Plastic and Reconstructive Surgery Department, St John's University Hospital, Howden Road West, Livingston, West Lothian, EH54 6PP, United Kingdom; Department of Oncological Surgery and Breast Diseases, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland. Electronic address: szychta@yahoo.pl.
authors: Pawel
authors: P
authors: Szychta
authors: Mark
authors: M
authors: Butterworth
authors: Mike
authors: M
authors: Dixon
authors: Dhananjay
authors: D
authors: Kulkarni
authors: Ken
authors: K
authors: Stewart
authors: Cameron
authors: C
authors: Raine
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D001940:Breast / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009068:Movement; D009121:Muscle Denervation / Q000009:adverse effects; D064827:Myocutaneous Flap / Q000294:innervation* / Q000473:pathology* / Q000637:transplantation; D009929:Organ Size; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D064171:Superficial Back Muscles / Q000294:innervation* / Q000637:transplantation
keywords: Breast reconstruction; Denervation; Flap; Innervation; Latissimus dorsi; Muscle atrophy; Volume loss