Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications

Background. Use of an autologous latissimus dorsi (LD) flap in breast reconstruction accounts for a flexible and natural look of reconstructed breast and has maintained a strong popularity because of its ease of harvest, reliability, and ability to provide additional prosthetic coverage. Different complications (hematoma, seroma, flap necrosis, infection, hypertrophic scarring, and postoperative back pain) linked to this type of breast reconstruction. The aim of this study was to evaluate the complications and aesthetic outcome of (LD) flap breast reconstruction after breast cancer surgery. Materials and methods. forty patients underwent breast reconstruction using (LD) flap with a follow-up period ranged from 6 to 18 months. Patients with small to medium sized breasts underwent complete reconstruction by extended (LD) flap after mastectomy either subcutaneous or skin sparing mastectomy while patients with large pendulous breast underwent Augmentation by (LD) miniflap after conservative surgery by wide local excision (WLE) with safety margin. All patients gave their informed consent for the procedure and were aware of the potential complications and the possibility of secondary procedures. Results. The ages of the patients in our study ranged from 25 to 65 years old. 28 (70%) patients underwent (WLE) and reconstruction with (LD) miniflap while modified radical mastectomy, skin sparing mastectomy and subcutaneous mastectomy were done in 2(5%), 4(10%) and 6(15%) patients respectively with complete reconstruction by extended(LD) flap. The complication rates were noted as follows: partial flap necrosis in 4 patients (10%), wound breakdown in 2 patients (5%), lymphorrhea in 2 patients (5%), seroma in 6 patients (15%). Some of patients showed a minor deformity in the back, which disappeared with time and most patients, had temporary limitation of shoulder movements postoperatively but all recovered completely within few weeks. No patients underwent secondary nipple and areola reconstruction. No local recurrence or distant metastasis in any patient during the follow up period of our study. Evaluation of aesthetic results by patients revealed that 30 patients (75%) were deeply satisfied, 6 patients (15%) were satisfied and 4 patients (10%) were poorly satisfied. While, surgeon aesthetic evaluation was good in 28 patients (70%), satisfactory in 8 patients (20%) and fair in 4 patients (10%). Conclusion. (LD) flap breast reconstruction is a very versatile, safe and satisfactory technique with high success rate and is even suitable for high-risk patients. Donor site seroma is the most common complication and can be treated by repeated aspiration in outpatient clinic. Latissimus dorsi (LD) miniflap is the mainstay of breast reconstruction after partial mastectomy to repair defects in the lateral quadrants and the lower inner pole with low donor site morbidity and deep patient satisfaction.