title: Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back.
abstract: BACKGROUND
  Results obtained with breast-conserving therapy are not always satisfactory. Reconstruction with a pure latissimus dorsi muscle flap is a useful option. The techniques described for endoscopic dissection of the flap create several scars on the back. As a result, they do not improve on the open approach, which causes a horizontal scar at the level of the bra strap. The authors' technique avoids all scars on the back using a single incision in the highest folds of the axilla, which also is used for the sentinel node biopsy or lymphadectomy and quadrantectomy.
  
  
  METHODS
  The study was performed with 23 patients. The tumor was extracted via a clockwise downward periareolar incision and via another incision in a fold of the axilla. Through this axillary incision, the sentinel lymph node biopsy or lymphadectomy was performed, and the external part of the latissimus dorsi muscle was harvested endoscopically for the reconstruction.
  
  
  RESULTS
  Both the medical team and the patients reported high satisfaction with the aesthetic and functional results due to the preservation of the breast shape and the absence of any scarring on the back.
  
  
  CONCLUSIONS
  Endoscopy-assisted techniques make either three small scars on the back or one long scar, with the muscle sectioned distally, or a vertical incision in the midaxillary line, which may form a hypertrophic or keloid scar. The authors' approach avoids the creation of these scars on the back because the endoscopy and the distal sectioning of the muscle flap are performed through the single axillary incision.
authors.affiliation: Aesthetic, Plastic and Reconstructive Surgery Department, Hospital Quirón Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain, serrarenom@gmail.com.
authors.forename: José M
authors.initials: JM
authors.lastname: Serra-Renom
authors.forename: José M
authors.initials: JM
authors.lastname: Serra-Mestre
authors.forename: Lourdes
authors.initials: L
authors.lastname: Martinez
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Andrea
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting / Q000379:methods; D014947:Wounds and Injuries / Q000601:surgery