The role of the Latissimus dorsi flap in reconstruction of the irradiated breast

Background: The role of the latissimus dorsi flap with a prosthesis in reconstruction of the previously irradiated breast is examined in this retrospective review of one surgeon's 10-year experience. Methods: Twenty-eight patients with available charts were divided into five groups: (1) 11 patients with previous breast conservation therapy and recurrence; (2) eight patients with previous mastectomy and radiation; (3) four patients with an expander that had been irradiated; (4) three patients with prior irradiation and implant reconstruction presenting for revision; and (5) two patients with breast deformity from breast conservation therapy. Results: Eighteen patients had a latissimus flap placed at the time of the expander and 10 had a latissimus flap at the time of implant placement or exchange. Average follow-up was 28.8 months (range, 1 week to 7 years). All patients had soft breasts at follow-up, with no evidence of capsular contracture. Donor-site complications included five donor-site seromas. The majority of patients (65 percent) underwent a planned two-stage reconstruction, and the majority of the revision operations were for exchanges to smaller implants. The response rate to a patient satisfaction survey was 67 percent. The average cosmetic satisfaction rating was 8.5 of 10 (with 10 being the highest). The average pain rating was 1.7 of 10 (with 10 being the worst). The overall satisfaction rating was 8.8 of 10. Fourteen of 16 patients indicated that they would undergo this procedure again. Conclusions: Although purely autologous reconstructions may be the best choice for many irradiated breasts, it has been shown in this study that a cosmetically acceptable reconstruction with manageable risk can be performed using a prosthesis combined with a latissimus dorsi flap.