Breast reconstruction using a latissimus dorsi flap after mastectomy.

INTRODUCTION The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover, in contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS A total of 135 unilateral LD breast reconstructions were performed in 126 women during the ten-year period. The median age of the women was 48.5 years, and they mainly had secondary reconstruction (90%). The average time to removal of the last drain was 6.3 days, and the average time to discharge was 6.9 days. A total of 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor site on the back. Patients who developed seroma were four times as likely as those who did not to be readmitted for antibiotic treatment. CONCLUSIONS LD breast reconstruction remains a safe choice for autologous breast reconstruction. Prevention of donor-site seroma as well as improvement of the clinical pathway and post-operative regimen could be future focus-points for this procedure. FUNDING The review was performed as part of the pre-graduate research year project, "Donor-site morbidity after m. latissimus dorsi reconstruction", funded by Concordiafonden. TRIAL REGISTRATION not relevant.