Breast reconstruction using muscle sparing latissimus dorsi flap and fat grafting

Introduction. - The aim of this study is to assess our results of autologous breast reconstruction using a combined muscle sparing latissimus dorsi flap (MSLD) and fat tissue transfer. Methods. - A prospective study was performed on 20 patients over a period of 1 year. Three objective criteria were analyzed: morphometric, surgical procedure and postoperative latissimus dorsi function. A subjective assessment was done using a 4-level scale for patients' and surgeons' satisfaction. Results. - Mean age of patients was of 45 +/- 1.2 years. The average Body Mass Index (BMI) was 21.9 +/- 2.2. The average weight of mastectomy specimen was 348.3 +/- 135.6 g. The average duration of the surgical procedure was 149 +/- 32.1 minutes. The average length of hospitalization was 4.5 +/- 1.4 days. The average quantity of dorsal drainage during the hospitalization was 117.7 +/- 41.5 cm(3), and a Visual Analog Scale (VAS) of pain of 2 +/- 0.9 over 10. Patients from our series had 0.8 +/- 0.9 dorsal punction per patient, with an average volume of seroma of 51.2 +/- 70.8 cm(3). Fat grafting was used in every case with an average number of 1.2 +/- 0.4 procedures per patient. The mean of injected volume was 250.1 +/- 132.8 cm(3). No complications occurred in the postoperative period. There was no difference of latissimus dorsi functional assessment at 3 months and 1 year postoperative. Conclusion. - Combined MSLD and fat transfer is a reliable and an efficient technique for autologous breast reconstruction. The donor site morbidity is low, the postoperative recovery is fast and functional integrity of latissimus dorsi muscle is preserved in all cases. This technique can be used in immediate or delayed autologous breast reconstruction, and is particularly useful for bilateral breast reconstruction. (C) 2012 Elsevier Masson SAS. All rights reserved.