SpringerLink
Log in

“No-back-scar” Latissimus Dorsi Muscle Flap and Tissue Expander: A Valuable Strategy for Secondary Breast Reconstructions

  • Original Articles
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

A Correction to this article was published on 03 April 2024

A Correction to this article was published on 05 September 2023

This article has been updated

Abstract

An overall complication rates for implant-based breast reconstruction (IBBR) have been reported from 29 to 46%, particularly in the setting of adjuvant radiotherapy. Although the majority of the literature describes autologous conversion in such scenario, a microsurgical flap is not always feasible. The aim of the paper is to assess surgical and patient-reported outcomes of breast reconstruction using a Latissimus Dorsi muscle Flap (LDMF), harvested without a back scar, in combination with a tissue expander for a two-staged reconstruction in the setting of a previously failed IBBR. All consecutive patients undergoing a two-stages LDMF IBBR between January 2016 and June 2020 were retrospectively identified. A minimal length vertical incision along the posterior axillary line was used for LD flap harvest. Demographic, clinical and surgical data were collected. Aesthetic outcome was evaluated with the Aesthetic Item Scale, and BREAST-Q was used to assess patients’ reported outcomes. Twenty-one patients met the inclusion criteria. Mean age was 45.6 years, and the average follow-up was 41.2 months after tissue expander replacement with definitive implant. All patients completed the secondary reconstructive procedure, without major complications both at reconstructive and donor flap site. All women reported to be very satisfied with the final breast reconstruction. Second-attempt implant-based breast reconstruction for patients with a previously failed IBBR is challenging. A conversion from prosthetic to a mixed breast reconstruction with a “no-back scar” LD flap and tissue expander can be considered as a valuable strategy, especially when an abdominal-based autologous breast reconstruction is not feasible or refused by the patients.

Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Change history

References

  1. Kimball CC, Nichols CI, Vose JG, Peled AW (2018) Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011–2016. Ann Surg Oncol 25:3867–3873

    Article  PubMed  Google Scholar 

  2. Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury R, Cromwell DA (2017) National trends in immediate and delayed post-mastectomy reconstruction procedures in England: a seven-year population-based cohort study. Eur J Surg Oncol Br Assoc Surg Oncol. 43(1):52–61

    Article  CAS  Google Scholar 

  3. Albornoz CR, Bach PB, Mehrara BJ, Disa JJ, Pusic AL, McCarthy CM et al (2013) A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg 131(1):15–23

    Article  CAS  PubMed  Google Scholar 

  4. Maxwell GP, Gabriel A (2014) The evolution of breast implants. Plast Reconstr Surg 134(1):12S-S17

    Article  PubMed  Google Scholar 

  5. Cordeiro PG, Jazayeri L (2016) Two-stage implant-based breast reconstruction: an evolution of the conceptual and technical approach over a two-decade period. Plast Reconstr Surg 138(1):1–11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Giudice G, Maruccia M, Nacchiero E, Elia R, Annoscia P, Vestita M (2018) Dual plane breast implant reconstruction in large sized breasts: How to maximise the result following first stage total submuscular expansion. JPRAS Open 1(15):74–80

    Article  Google Scholar 

  7. El-Sabawi B, Sosin M, Carey JN, Nahabedian MY, Patel KM (2015) Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol 112(5):458–464

    Article  PubMed  Google Scholar 

  8. Asaad M, Slovacek C, Mitchell D, Liu J, Selber JC, Clemens MW et al (2022) Implant-based breast reconstruction following infected device explantation: is a second attempt worth it? Plast Reconstr Surg 150(2):247e-e259

    Article  CAS  PubMed  Google Scholar 

  9. Delay E, Florzac AS, Frobert P (2018) Breast reconstruction with the autologous latissimus dorsi flap. Ann Chir Plast Esthet 63(5–6):422–436

    Article  CAS  PubMed  Google Scholar 

  10. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

    Article  Google Scholar 

  11. Visser NJ, Damen THC, Timman R, Hofer SOP, Mureau MAM (2010) Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg 126(1):26–36

    Article  CAS  PubMed  Google Scholar 

  12. Sue GR, Sun BJ, Lee GK (2018) Complications after two-stage expander implant breast reconstruction requiring reoperation: a critical analysis of outcomes. Ann Plast Surg 80(5S):S292–S294

    Article  CAS  PubMed  Google Scholar 

  13. Spear SL, Masden D, Rao SS, Nahabedian MY (2013) Long-term outcomes of failed prosthetic breast reconstruction. Ann Plast Surg 71(3):286–291

    Article  CAS  PubMed  Google Scholar 

  14. Hamdi M, Casaer B, Andrades P, Thiessen F, Dancey A, D’Arpa S et al (2011) Salvage (tertiary) breast reconstruction after implant failure. J Plast Reconstr Aesthet Surg JPRAS. 64(3):353–359

    Article  PubMed  Google Scholar 

  15. Hamdi M, Andrades P, Thiessen F, Stillaert F, Roche N, Van Landuyt K et al (2010) Is a second free flap still an option in a failed free flap breast reconstruction? Plast Reconstr Surg 126(2):375–384

    Article  CAS  PubMed  Google Scholar 

  16. Levine SM, Lester ME, Fontenot B, Allen RJ (2011) Perforator flap breast reconstruction after unsatisfactory implant reconstruction. Ann Plast Surg 66(5):513–517

    Article  CAS  PubMed  Google Scholar 

  17. Roostaeian J, Yoon AP, Ordon S, Gold C, Crisera C, Festekjian J et al (2016) Impact of Prior Tissue Expander/Implant on Postmastectomy Free Flap Breast Reconstruction. Plast Reconstr Surg 137(4):1083–1091

    Article  CAS  PubMed  Google Scholar 

  18. Ascherman JA, Hanasono MM, Newman MI, Hughes DB (2006) Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg 117(2):359–365

    Article  CAS  PubMed  Google Scholar 

  19. Murphy BD, Kerrebijn I, Farhadi J, Masia J, Hofer SO (2018) Indications and controversies for abdominally based complete autologous tissue breast reconstruction. Clin Plast Surg 45(1):83–91

    Article  PubMed  Google Scholar 

  20. Tomita K, Yano K, Nishibayashi A, Fukai M, Miyasaka M, Hosokawa K (2013) The role of latissimus dorsi myocutaneous flaps in secondary breast reconstruction after breast-conserving surgery. Eplasty 11(13):e28

    Google Scholar 

  21. Slovacek C, Asaad M, Mitchell D, Selber JC, Clemens MW, Chu CK et al (2022) Does a latissimus dorsi flap improve surgical outcomes of implant-based breast reconstruction following infected device explantation? Plast Reconstr Surg Glob Open 10(8):e4409

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kokosis G, Khavanin N, Nahabedian MY (2019) Latissimus dorsi musculocutaneous flap for complex breast reconstruction: indications, outcomes and a proposed algorithm. Plast Reconstr Surg Glob Open 7(8):e2382

    Article  PubMed  PubMed Central  Google Scholar 

  23. Elliott LF, Ghazi BH, Otterburn DM (2011) The scarless latissimus dorsi flap for full muscle coverage in device-based immediate breast reconstruction: an autologous alternative to acellular dermal matrix. Plast Reconstr Surg 128(1):71–79

    Article  CAS  PubMed  Google Scholar 

  24. Sood R, Easow JM, Konopka G, Panthaki ZJ (2018) Latissimus dorsi flap in breast reconstruction: recent innovations in the workhorse flap. Cancer Control J Moffitt Cancer Cent 25(1):1073274817744638

    Google Scholar 

  25. Feng Y, Wen N, Liang F, Zhou J, Qin X, Liu X et al (2022) Endoscopic Nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: a preliminary experience of an innovative technique. Breast J 2022:1373899

    Article  PubMed  PubMed Central  Google Scholar 

  26. Maruccia M, Elia R, Ciudad P, Nacchiero E, Nicoli F, Vestita M et al (2019) Postmastectomy upper limb lymphedema: combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients’ related outcomes. a retrospective comparative study. J Plast Reconstr Aesthetic Surg JPRAS. 72(6):892–901

    Article  CAS  Google Scholar 

  27. Maruccia M, Pezzolla A, Nacchiero E, Dicillo P, Macchia L, Fiore P et al (2019) Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema. Microsurgery 39(8):679–687

    Article  PubMed  Google Scholar 

  28. Nacchiero E, Maruccia M, Vestita M, Elia R, Marannino P, Giudice G (2019) Multiple lymphatic-venous anastomoses in reducing the risk of lymphedema in melanoma patients undergoing complete lymph node dissection. A retrospective case-control study. J Plast Reconstr Aesthet Surg JPRAS 72(4):642–8

    Article  PubMed  Google Scholar 

  29. Peled AW, Foster RD, Esserman LJ, Park CC, Hwang ES, Fowble B (2012) Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plast Reconstr Surg 130(3):503–509

    Article  CAS  PubMed  Google Scholar 

  30. Hardwicke JT, Prinsloo DJ (2011) An analysis of 277 consecutive latissimus dorsi breast reconstructions: a focus on capsular contracture. Plast Reconstr Surg 128(1):63–70

    Article  CAS  PubMed  Google Scholar 

  31. Bucaria V, Elia R, Maruccia M, Annoscia P, Boccuzzi A, Giudice G (2018) Why choose the septum-supero-medial (SSM)-based mammaplasty in patients with severe breast ptosis: an anatomical point of view. Aesthet Plast Surg 42(6):1439–1446

    Article  CAS  Google Scholar 

  32. Iwahira Y, Nakagami G, Sanada H (2022) Risk factors for capsular contracture after breast reconstruction with tissue expanders and silicone implants in nonirradiated patients: a retrospective observational cohort study. Medicine (Baltimore) 101(48):e31837

    Article  PubMed  Google Scholar 

  33. Bittar SM, Sisto J, Gill K (2012) Single-stage breast reconstruction with the anterior approach latissimus dorsi flap and permanent implants. Plast Reconstr Surg 129(5):1062–1070

    Article  CAS  PubMed  Google Scholar 

  34. Santosa KB, Chen X, Qi J, Ballard TNS, Kim HM, Hamill JB et al (2016) Post-mastectomy radiation therapy (pmrt) and two-staged implant-based breast reconstruction: is there a better time to radiate? Plast Reconstr Surg 138(4):761–769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kung TA, Kidwell KM, Speth KA, Pang JC, Jagsi R, Newman LA et al (2018) Radiation-induced skin changes after postmastectomy radiation therapy: a pilot study on indicators for timing of delayed breast reconstruction. J Reconstr Microsurg 35(03):209–215

    Article  PubMed  Google Scholar 

  36. Maruccia M, Di Taranto G, Onesti MG (2018) One-stage muscle-sparing breast reconstruction in elderly patients: a new tool for retaining excellent quality of life. Breast J 24(2):180–183

    Article  PubMed  Google Scholar 

  37. Maruccia M, Mazzocchi M, Dessy LA, Onesti MG (2016) One-stage breast reconstruction techniques in elderly patients to preserve quality of life. Eur Rev Med Pharmacol Sci 20(24):5058–5066

    CAS  PubMed  Google Scholar 

  38. Clemens MW, Kronowitz SJ (2012) Acellular dermal matrix in irradiated tissue expander/implant-based breast reconstruction: evidence-based review. Plast Reconstr Surg 130(5 Suppl 2):27S-34S

    Article  CAS  PubMed  Google Scholar 

  39. Sorkin M, Qi J, Kim HM, Hamill JB, Kozlow JH, Pusic AL et al (2017) Acellular dermal matrix in immediate expander/implant breast reconstruction: a multicenter assessment of risks and benefits. Plast Reconstr Surg 140(6):1091–1100

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

All authors hereby declare not to have any potential conflict of interests and not to have received funding for this work. Each author participated sufficiently in the work to take public responsibility for the content and agree to its publication.

Author information

Authors and Affiliations

  1. Unit of Plastic and Reconstructive Surgery, Mater Dei Hospital, 10 v. Samuel F Hahnemann, 70125, Bari, Italy

    Vincenzo Bucaria, Alessandra Boccuzzi & Ilaria Converti

  2. Unit of Plastic and Reconstructive Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 11, Piazza Giulio Cesare, 70124, Bari, Italy

    Giuseppe Giudice, Michele Maruccia & Elia Rossella

Authors
  1. Vincenzo Bucaria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Giudice
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandra Boccuzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilaria Converti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michele Maruccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elia Rossella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elia Rossella.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

The principles outlined in the Declaration of Helsinki on medical protocols and ethics have been attended for this study. Women who have undergone two-stage LD flap were exhaustively informed of all possible risks and benefits of the procedure. All the other available reconstructive techniques were illustrated to them, and the best option was chosen according to the patient's clinical needs.

Informed Consent

A written informed consent with detailed information concerning the advantages, disadvantages and complication rates of the surgical procedure was obtained from all patients prior to surgery.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bucaria, V., Giudice, G., Boccuzzi, A. et al. “No-back-scar” Latissimus Dorsi Muscle Flap and Tissue Expander: A Valuable Strategy for Secondary Breast Reconstructions. Aesth Plast Surg 48, 2098–2107 (2024). https://doi.org/10.1007/s00266-023-03595-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03595-6

Keywords

Search

Navigation