Background: Extensive dissection of the Latissimus dorsi (LD) myocutaneous flap is defined as dissecting the entire LD myocutaneous flap and fatty tissue overlying the muscle with a large skin paddle, improving the aesthetic result of immediate reconstruction. This technique enables autogenous tissue reconstruction possible in most Thai patients.

Objective: The aim of this study is to examine patients who performed mastectomy followed by extended LD flap reconstruction technique with general data, complications, aesthetic results and postoperative assessment of shoulder functions after extended LD muscle harvesting.

Material and Method: Between February 2005 and February 2008, 81 mastectomies with extensive dissection of LD myocutaneous flap were performed on 76 patients. Surgical oncologists prospectively followed-up patients for complications and aesthetic results. The data reported 95% confidence interval of odd ratio (95% CI of OR).

Results: Extensive dissection of LD myocutaneous flap was performed for bilateral breast cancer (n = 2) and breast cancer prophylaxis (bilateral LD flap, n = 3), chest wall recurrence (n = 2), ductal carcinoma in situ (DCIS) and DCIS with microinvasion (n = 14), locally-advanced breast cancer (LABC) (n = 5), and infiltrating carcinoma (n = 50). The mean age of the patients was 44.26 years (95% CI of the difference = 42.34 to 46.18). Twenty-three patients had seroma formation at the donor site, requiring a single-needle, occasionally two times, aspiration after removal of the drains. The length of stay in the hospital ward was 2 days (95% CI of the difference = 2.45 to 3.19). At a median follow-up time of 107 months (range 84.18 to 117.06), there was moderate degree LD flap atrophy. No morbidity after LD muscle harvesting was detected. The donor site scar with contour was generally very good. All patients who facilitated this surgical technique had excellent cosmetic results.

Conclusion: Overall, we found that the extended LD-flap technique provided excellent aesthetic results with infrequent complications. Furthermore, in this small series, we found some degree muscle atrophy. We continue to offer this technique for all Thai patients, including those desiring surgical breast cancer prophylaxis as well as those with DCIS.

Keywords: Extended LD flap technique, Breast reconstruction, Seroma formation, Breast cancer