Assessment of the technique of lipofilling of latissimus dorsi muscle flap for immediate breast reconstruction after mastectomy

Abdullatif, Ahmed; Nagi, Ahmed; Elfayoumy, Tarek A.; Elrakshy, Mohamed T.; Asal, Mohamed F.

doi:10.4103/ejs.ejs_313_22

Assessment of the technique of lipofilling of latissimus dorsi muscle flap for immediate breast reconstruction after mastectomy

Authors

Abstract

Background
Breast cancer is the commonest cancer among women, accounting for ∼30.7% of all incident cancers among women. Conservative mastectomies such as skin-sparing mastectomy and nipple-sparing mastectomy aim for breast reconstruction, thus improving the quality of life and the psychological damages in patients with breast cancer. Breast reconstruction can be done either immediately or delayed, using prosthesis as implants or temporary expanders or autogenous tissue as flaps from the anterior abdominal wall as the transverse rectus abdominis myocutaneous flap (TRAM) or deep inferior epigastric artery perforator flap (DIEP) flaps or from the back as the latissimus dorsi (LD) flap.
Aim
The present study assesses the lipofilled LD muscle flap in immediate autologous breast reconstruction after mastectomy as regards feasibility, complications, and cosmetic outcome.
Patients and methods
The present study was conducted on 20 patients with breast cancer, who were candidates for skin-sparing mastectomy, nipple-sparing mastectomy, or skin-reducing mastectomy and aiming for complete autologous breast reconstruction. Patients were admitted to the Surgical Oncology Unit, Alexandria Main University Hospital.
Results
Majority of patients (12 patients) were of age less than 50 years with a BMI ranging from 23.2 to 35. Fourteen (70%) patients had moderate breast size (cup B) and 12 patients received neoadjuvant chemotherapy. Operative time ranged from 105 to 225 min. Size of the flap ranged from 150 to 300 cm with the harvested fat ranging from 180 to 300 ml. Complications were detected in six patients mostly back seroma and one case of flap necrosis and wound dehiscence and one case of LD muscle twitches. Most of the patients were very to moderately satisfied with the final outcome with two cases needed relipofilling after a follow-up for about 18 months.
Conclusion
Lipofilling of the LD myocutaneous flap aiming for breast reconstruction following mastectomy is an easy, versatile technique that overcomes the drawback of the small-sized LD flap and need for implants. The technique shows excellence in terms of neoadjuvant setting and in correction of complication of implants.

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