title: Latissimus dorsi flap for total autologous immediate breast reconstruction without implants.
abstract: BACKGROUND
  The latissimus dorsi flap provides suitable recipient tissue for fat transfer, with a good blood supply and a reasonable volume of host tissue to inject into. The authors present their experience with use of the pedicled latissimus dorsi flap for fat grafting in total autologous immediate breast reconstruction without implants.
  
  
  METHODS
  From 2010 to 2013, 23 patients underwent breast reconstruction with primary fat augmented latissimus dorsi flaps (21 unilateral procedures and two bilateral procedures). Mean patient age was 52.3 years (range, 39 to 68 years); mean body mass index was 24.77 kg/m2 (range, 21.5 to 28.7 kg/m2). Fat was harvested using the Coleman technique with 10-ml syringes and injected into the adipose layer and muscle fascia of the latissimus dorsi flap skin paddle with 1-ml syringes.
  
  
  RESULTS
  The mean size of the harvested skin paddle was 19.7 × 11.04 cm (range, 18 × 10 cm to 21 × 12 cm). Mean operative time was 2.62 hours (range, 2.10 to 3.20 hours) and 4.12 hours (range, 4.10 to 4.15 hours) for unilateral and bilateral reconstructions, respectively. Mean harvested fat volume was 126 ml (range, 90 to 180 ml), and mean injected fat volume was 101 ml (range, 60 to 150 ml). All flaps healed uneventfully, no seroma occurred at the flap donor-site, and no fat grafting-related complications were observed.
  
  
  CONCLUSIONS
  To the best of the authors' knowledge, this is the first report in which fat transfer was used to achieve immediate latissimus dorsi flap volume augmentation as an alternative for total autologous reconstruction, avoiding implant-related complications.
authors.affiliation: Rome, Italy From the Plastic Surgery Department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli di Pompeo
authors.forename: Rosaria
authors.initials: R
authors.lastname: Laporta
authors.forename: Michail
authors.initials: M
authors.lastname: Sorotos
authors.forename: Marco
authors.initials: M
authors.lastname: Pagnoni
authors.forename: Federica
authors.initials: F
authors.lastname: Falesiedi
authors.forename: Benedetto
authors.initials: B
authors.lastname: Longo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015411:Mastectomy, Modified Radical; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D012189:Retrospective Studies; D050151:Subcutaneous Fat / Q000637:transplantation; D064171:Superficial Back Muscles / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome