Latissimus dorsi flap salvage of the partially failed TRAM flap breast reconstruction

Background: The transverse rectus abdominis musculocutaneous (TRAM) flap is an excellent option for patients desiring autogenous breast reconstruction. However, partial flap ischemia can result in isolated areas of skin and fat necrosis, which, when removed, can create irregular and sharply defined defects that distort the aesthetic appearance of the reconstructed breast. Such defects can be difficult to reconstruct with local-tissue rearrangement or with breast implants. Methods: A subset of patients undergoing TRAM flap breast reconstruction who experienced significant partial flap necrosis was identified. After debridement, 14 consecutive patients subsequently underwent revision reconstruction with an autogenous, volume-added latissimus dorsi musculocutaneous flap. Demographic data and results in this subgroup of patients were collected. Results: All patients in the study experienced significant deformity in the reconstructed breast as a result of the removal of the necrotic tissue. The irregular and sharply defined defect was filled in completely and smoothly with the autogenous latissimus dorsi flap, obviating the need for an implant. The flap survival rate was 100 percent as the latissimus dorsi flap provided a reliable volume of soft tissue with which to fill in the defect in the breast, thus preserving the autologous nature of the reconstruction. Conclusion: Using the latissimus dorsi musculocutaneous flap as soft-tissue filler enables restoration of appropriate volume and an aesthetic shape to the reconstructed breast in patients who have developed fat necrosis after TRAM flap breast reconstruction.