Outcome of Mastectomy with Immediate LD Flap Reconstruction by the Extended LD Flap Technique
Prakasit Chirappapha MD*, Youwanush Kongdan MD*, Chairat Supsamutchai MD*, Teerawut Rakchob MD*, Thongchai Sukarayothin MD*, Monchai Leesombatpaiboon MD*, Panuwat Lertsithichai MD*
Affiliation : * Department of surgery, Ramathibodi Hospital Faculty of Medicine, Mahidol University, Bangkok, Thailand
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 micro-
invasion (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
