Evolving concepts in breast reconstruction with latissimus dorsi flaps: Results and follow-up of 121 consecutive patients

Breast reconstruction using autologous tissue is increasingly gaining in in terest. A review of results obtained from a series of consecutive patients undergoing breast reconstruction with the latissimus dorsi flap (LDF) was c arried out to evaluate the effects of the authors' refinements to the proce dure. Data collected during the perioperative course and a minimum follow-u p of 12 months in 121 patients (mean age, 47 years; 50% with previous radio therapy) who underwent treatment from 1994 to 1998 were analyzed retrospect ively. In addition, a structured interview was conducted to evaluate patien t satisfaction. Eighteen different surgeons in one teaching hospital were i nvolved in the operative procedures. No patient was referred to the intensi ve care unit. An additional implant was used in 25% of patients. With the e xception of the occurrence of seroma, the complication rate was low (seroma , 60%; bleeding, 4%; hematoma, 5%; minor wound dehiscence, 3%; wound infect ion, 2%). No flap was lost. Donor site morbidity was extremely low; 90% of patients had no complaints. The result of surgery was rated as excellent or good by 59% of patients, 89% would undergo this type of breast reconstruct ion again, and 91% would recommend it to other women. Refinements that impr oved the technique substantially included incision lines exclusively in the bra line, improved flap volume resulting from the harvest of an extended f at pad, and quilting sutures to reduce the formation of seroma. In the curr ent study, endoscopic muscle harvest did not represent an improvement in pr ocedure. The technique of breast reconstruction with the LDF has been impro ved substantially during the past few years, and provides the plastic surge on with an excellent, safe, and consistently successful method for breast r econstruction.