Breast reconstruction with a latissimus dorsi musculocutaneous flap after amputation for cancer. Apropos of 45 cases with a 9-year follow-up
Talmant, J.C.
Annales de Chirurgie Plastique et Esthetique 36(4): 320-329
1991
ISSN/ISBN: 0294-1260 PMID: 1724886 Document Number: 384714
Breast reconstruction following mastectomy for cancer using a latissimus dorsi myocutaneous flap must always be completed by insertion of a prosthesis. In 76% of our cases, it was associated with surgery on the contralateral breast to produce symmetry. By following this therapeutic plan using a flap as large as possible taken in the line of the strap of the brassiere, and raised with a large expanse of muscle to completely cover the prosthesis, the aesthetic results were uniformly good. This applies to the mastectomy patients without adjuvant therapy. All the mediocre and poor results were observed in the patients who had undergone radiotherapy. The most severe post radiotherapy complications (8.7% of our series) with progressive fibrosis and chest wall retraction, fortunately rare today, are a contraindication to this type of reconstruction. This case requires very large soft tissue transfer with a rectus abdominis myocutaneous flap. This is a much larger procedure for the patient. 91% of post radiotherapy patients are satisfied with the result with a follow-up of up to 9 years demonstrating good stability. Despite this only 74% of the results were considered to be good by the surgeon. So 17% could be improved and this suggests new efforts in two directions: 1) To avoid the most frequent cause which is the formation of a capsule. The availability of the new textured prosthesis is a good reason to hope for a decreased incidence, but the follow-up 18 month is not yet long enough to confirm this. 2) To routinely position the flap in the lower outer quadrant respecting the principle of aesthetic units.