title: Maximizing the Volume of Latissimus Dorsi Flap in Autologous Breast Reconstruction with Simultaneous Multisite Fat Grafting.
abstract: BACKGROUND
  The pedicled latissimus dorsi (LD) flap serves an important function in breast reconstruction, but its utility is limited by its inability to provide sufficient breast volume.
  
  
  OBJECTIVE
  The purpose of this preliminary report was to review the techniques and outcomes of utilizing fat-grafted, volume-enhanced LD flap transfer with fat grafting recipient sites in autologous breast reconstruction.
  
  
  METHODS
  A retrospective study was performed of 10 patients (14 breasts) who underwent autologous breast reconstruction utilizing the LD flap transfer technique and simultaneous fat grafting between August 2012 and September 2014. Multilayer, multisite fat grafting was performed to the LD muscle, LD skin paddle, mastectomy skin flaps, and the pectoralis major and serratus muscles simultaneously with the LD flap transfer.
  
  
  RESULTS
  Three patients underwent an immediate breast reconstruction, four underwent a delayed breast reconstruction, and four underwent a tertiary breast reconstruction following previously failed breast reconstructions (one patient underwent each of the first two procedures, one on each breast). The average age of the patients was 55 years (range, 39-76 years), the average body mass index of the patients was 29.3 (range, 19.6-39.9), and the average fat grafting volume for the patients was 176 mL (range, 50-300 mL). There was 100% flap survival and complete wound healing. No seroma or fat grafting-related complications were clinically detected. Three patients required additional fat grafting.
  
  
  CONCLUSIONS
  The fat-grafted, volume-enhanced LD flap procedure with fat grafting recipient sites offers a simple and safe technique for autologous breast reconstruction, with low morbidity and fast recovery. It can be a useful alternative to utilizing abdomen-based flaps in autologous breast reconstruction or could be performed to salvage both implant-based and free-flap breast reconstructions. LEVEL OF EVIDENCE 4: Therapeutic.
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Anita T
authors.initials: AT
authors.lastname: Mohan
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Vijayasekaran
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Hou
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Yoo Joon
authors.initials: YJ
authors.lastname: Sur
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Morsy
authors.affiliation: Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D061665:Time-to-Treatment; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing