title: The role of latissimus dorsi myocutaneous flaps in secondary breast reconstruction after breast-conserving surgery.
abstract: OBJECTIVE
  Secondary reconstruction after breast-conserving surgery is generally challenging because of the nature of irradiated tissue. The aim of this study was to validate the use of latissimus dorsi myocutaneous (LDM) flaps for secondary breast reconstruction after breast-conserving surgery.
  
  
  METHODS
  Fifteen consecutive patients who underwent secondary reconstruction with an LDM flap after breast-conserving surgery were included in the study. The esthetic outcome in comparison with the contralateral breast was evaluated by observer assessments consisting of 7 criteria. In addition to comparing pre- and postoperative scores for each criterion, factors affecting overall esthetic outcome were analyzed.
  
  
  RESULTS
  There was no major recipient- or donor-related complication. In 13 patients, the skin paddle of the LDM flap was exposed to the skin surface. In all patients, overall esthetic scores increased postoperatively. Age, period between breast-conserving surgery and LDM flap, body mass index, or preoperative breast size did not affect the overall esthetic outcome. Tumors in the lower quadrants tended to result in poorer esthetic scores, especially in breast shape and scar (P = .04 and .02, respectively).
  
  
  CONCLUSIONS
  Given their high vascularity and moderate flap volume, LDM flaps could be a reliable option for secondary breast reconstruction after breast-conserving surgery. Although exposure of skin paddle to the skin surface is inevitable in most cases, esthetic improvement could be achieved, including the breast scar. On the contrary, immediate reconstruction would certainly be more desirable, especially in cases of tumors in the lower quadrants.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomita
authors.forename: Kenji
authors.initials: K
authors.lastname: Yano
authors.forename: Akimitsu
authors.initials: A
authors.lastname: Nishibayashi
authors.forename: Megumi
authors.initials: M
authors.lastname: Fukai
authors.forename: Miwako
authors.initials: M
authors.lastname: Miyasaka
authors.forename: Ko
authors.initials: K
authors.lastname: Hosokawa