title: The use of contralateral free extended latissimus dorsi myocutaneous flap for a tertiary failed breast reconstruction: Is it still an option?
abstract: BACKGROUND
  Unsuccessful breast reconstruction management represents a complex challenge for the plastic surgeon. Although these events rarely occur, many patients are not suitable candidates for conventional flaps, because of either previous donor-site surgery or lack of sufficient tissue.
  
  
  METHODS
  In this study, a contralateral free latissimus dorsi musculocutaneous flap (CL-LDMF) was planned for correction of major lesions in the anterior chest wall. Twelve patients underwent secondary/tertiary breast reconstruction with CL-LDMF with a customized shape (horizontal, oblique, or "fleur-de-lis") depending on the amount of tissue necessary. The technique was indicated in patients with large thoracic defects who lacked a donor site and had undergone previous unsuccessful pedicled LDMF.
  
  
  RESULTS
  The mean follow-up time was 42.5 months (range: 18-72 months). Five local complications occurred in four of the 12 patients. Dorsal dehiscence was observed in one, local wound infection in one, small partial CL-LDMF necrosis in one, and dorsal seroma in one patient. All cases of complications were limited and treated with a conservative approach except for one implant extrusion 4 months after reconstruction. No total flap loss was reported. All patients achieved a satisfactory thoracic and breast reconstruction.
  
  
  CONCLUSIONS
  The results of this study demonstrate that free CL-LDMF is a reliable technique and should be considered in selected cases of tertiary reconstructions. The majority of complications were immediate, minor, and comparable to other reconstructive techniques. We believe that in selected patients, especially those who do not have available donor-site areas, free CL-LDMF is advantageous and should be part of the armamentarium of all plastic surgeons who deal with tertiary breast reconstructions.
authors.affiliation: Division of Plastic Surgery, Cancer Institute of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: munhozalex@uol.com.br.
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.affiliation: Division of Plastic Surgery, Cancer Institute of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.affiliation: Division of Plastic Surgery, Cancer Institute of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Eduardo Gustavo
authors.initials: EG
authors.lastname: Arruda
authors.affiliation: Division of Plastic Surgery, Cancer Institute of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Okada
authors.affiliation: Division of Plastic Surgery, Cancer Institute of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Fonseca
authors.affiliation: Breast Division, Cancer Institute of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Filassi
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D064171:Superficial Back Muscles; D017211:Treatment Failure; D055815:Young Adult
keywords: Breast cancer; Breast reconstruction; Complication; Latissimus dorsi myocutaneous flap; Microsurgery; Total failure