title: [Breast reconstruction by latissimus dorsi flap: Towards an evolution of ideas].
abstract: OBJECTIVE
  Breast reconstruction with latissimus dorsi flap and fat grafting is a technique widely used in current practice. Some operators still complain at the lack of final results at the first intervention and the need for repeated lipofilling sessions. The objective of this study was to compare the number of reoperations in patients who underwent reconstruction with latissimus dorsi with prosthesis versus without prosthesis.
  
  
  METHODS
  We included all patients operated for breast reconstruction with latissimus dorsi flap, with or without prosthesis between 2008 and 2012 in our center. We noted the number of new surgical interventions in these patients on the reconstructed breast. We also noted the average weight of mastectomy in two groups each year.
  
  
  RESULTS
  One hundred and eighty-six patients were included in this study. Ninety-one patients underwent reconstruction with latissimus dorsi and prosthesis, and 95 patients reconstruction by latissimus dorsi and fat graft. It has not been demonstrated significant differences in the number of new surgical procedures between the two groups. The average weight of mastectomies in the autologous group has steadily increased over the five years. There was no significant difference in the average weight of mastectomies between the two groups over the last two years.
  
  
  CONCLUSIONS
  For breast reconstruction with latissimus dorsi flap, surgical indications changed in our center to the absence of prosthetic implant, whatever the volume of the breast.
authors.affiliation: Centre de lutte contre le cancer René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France. Electronic address: j.niddam@yahoo.fr.
authors.forename: J
authors.initials: J
authors.lastname: Niddam
authors.affiliation: Centre de lutte contre le cancer René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: T
authors.initials: T
authors.lastname: Guihard
authors.affiliation: Centre de lutte contre le cancer René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: I
authors.initials: I
authors.lastname: Cothier-Savey
authors.affiliation: Centre de lutte contre le cancer René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: H
authors.initials: H
authors.lastname: Chaussard
authors.affiliation: Centre de lutte contre le cancer René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: P
authors.initials: P
authors.lastname: Lemasurier
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D018427:Breast Implants; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000637:transplantation*
keywords: Breast; Fat grafting; Grand dorsal; Implant; Latissimus dorsi; Lipofilling; Reconstruction; Sein