Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients
Tóm tắt
Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery.
A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction.
The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases.
The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.
Tài liệu tham khảo
Huang NS, Quan CL, Ma LX, Si J, Chen JJ, Yang BL, Huang XY, Liu GY, Shen ZZ, Shao ZM, Wu J. Current status of breast reconstruction in China: an experience of 951 breast reconstructions from a single institute. Gland Surg. 2016;5(3):278–86.
Levine SM, Lester ME, Fontenot B, Allen RJ. Perforator flap breast reconstruction after unsatisfactory implant reconstruction. Ann Plast Surg. 2011;66(5):513–7.
Lai HW, Chen ST, Lin SL, Lin YL, Wu HK, Pai SH, Chen DR, Kuo SJ. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer: a case report. Medicine (Baltimore). 2018;97(27):e11373.
Iglesias M, Gonzalez-Chapa DR. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases. Aesthetic Plast Surg. 2013;37(4):719–27.
Ma JX, Xia YC, Li B, Zhao HM, Lei YT. Unilateral tissue expander/implant two-stage breast reconstruction with the assistance of three-dimensional surface imaging. Aesthetic Plast Surg. 2020;44(1):60–9.
Zheng H, Zhu G, Guan Q, Fan W, Li X, Yu M, Xu J, Wu X. A retrospective study of latissimus dorsi flap in immediate breast reconstruction. Front Oncol. 2021;11:598604.
Tepper OM, Karp NS, Small K, Unger J, Rudolph L, Pritchard A, Choi M. Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction. Breast J. 2008;14(6):543–50.
Spear SL, Baker JL Jr. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg. 1995;96(5):1119–23.
Lee J, Jung JH, Kim WW, Park CS, Lee RK, Park HY. Endoscopy-assisted muscle-sparing Latissimus Dorsi muscle flap harvesting for partial breast reconstruction. BMC Surg. 2020;20(1):192.
Feng J, Pardoe CI, Mota AM, Chui CH, Tan BK. Two-stage latissimus dorsi flap with implant for unilateral breast reconstruction: getting the size right. Archi Plast Surg. 2016;43(2):197–203.
Kronowitz SJ. Delayed-immediate breast reconstruction: technical and timing considerations. Plast Reconstr Surg. 2010;125(2):463–74.
Clemens MW, Kronowitz S, Selber JC. Robotic-assisted latissimus dorsi harvest in delayed-immediate breast reconstruction. Semin Plast Surg. 2014;28(1):20–5.
de Runz A, Boccara D, Bekara F, Chaouat M, Mimoun M. Outcome of 122 delayed breast reconstruction following post-mastectomy radiotherapy: the scarless latissimus dorsi flap with tissue expansion technique. Ann Chir Plast Esthet. 2017;62(1):23–30.
Yang CE, Roh TS, Yun IS, Kim YS, Lew DH. Immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest. Arch Plast Surg. 2014;41(5):513–9.
Masuoka T, Fujikawa M, Yamamoto H, Ohyama T, Inoue Y, Takao T, Hosokawa K. Breast reconstruction after mastectomy without additional scarring: application of endoscopic latissimus dorsi muscle harvest. Ann Plast Surg. 1998;40(2):123–7.
Salibi A, Hart AM. Articulated endoscopic linear cutter stapler facilitates minimal access harvest of the latissimus dorsi muscle flap for chest wall reconstruction in Poland syndrome. Plast Reconstr Surg. 2014;134(5):856e-8e.
Serra-Renom JM, Serra-Mestre JM, Martinez L, D’Andrea F. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back. Aesthetic Plast Surg. 2013;37(5):941–9.
Xu S, Tang P, Chen X, Yang X, Pan Q, Gui Y, Chen L. Novel technique for laparoscopic harvesting of latissimus dorsi flap with prosthesis implantation for breast reconstruction: a preliminary study with 2 case reports. Medicine (Baltimore). 2016;95(46):e5428.
Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg. 2012;129(6):1305–12.
Ichihara S, Bodin F, Pedersen JC, Porto de Melo P, Garcia JC Jr, Facca S, Liverneaux PA. Robotically assisted harvest of the latissimus dorsi muscle: a cadaver feasibility study and clinical test case. Hand Surg Rehabil. 2016;35(2):81–4.
Liu C, Luan J, Ouyang Y, Zhuang Y, Xu B, Chen L, Li S, Fu S, Xin M. Breast reconstruction in Poland syndrome patients with latissimus dorsi myo flap and implant: an efficient endoscopic approach using single transverse axillary incision. Aesthetic Plast Surg. 2019;43(5):1186–94.
Missana MC, Pomel C. Endoscopic latissimus dorsi muscle flap harvesting. Am J Surg. 2007;194(2):164–9.
Chung JH, You HJ, Kim HS, Lee BI, Park SH, Yoon ES. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg. 2015;68(7):966–72.
Yezhelyev M, Duggal CS, Carlson GW, Losken A. Complications of latissimus dorsi flap breast reconstruction in overweight and obese patients. Ann Plast surg. 2013;70(5):557–62.