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The Prevention of Implant Malposition in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction using an Acellular Dermal Matrix Following an Extensive Oncologic Resection: A Clinical Review
Milind D. Kachare, M.D.
Brooke Barrow, M.Eng.
Swapnil D. Kachare, M.D.
Samuel Corey, M.D.
Bradon J. Wilhelmi, M.D.
University of Louisville - Division of Plastic Surgery
2021-02-22
Presenter: Milind D. Kachare
Affidavit:
This project is entirely the original work of the fellow, Milind Kachare.
Director Name: Bradon J. Wilhelmi
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: A latissimus dorsi myocutaneous flap with an implant is an established method for breast reconstruction. One known risk factor with this technique is implant malposition, which has a higher incidence in patients requiring an extensive oncologic resection. One option to mitigate the risk of implant malposition is using an acellular dermal matrix (ADM) for structural support; however, the use of ADM with latissimus flaps is not well-reported. This retrospective review investigates a series of 30 patients who underwent reconstruction using a latissimus dorsi flap with a subpectoral implant placement and ADM after an extensive lateral dissection for advanced disease and radiation therapy.
Methods: A retrospective chart review was conducted to identify all patients who underwent a latissimus flap with implant breast reconstruction and ADM following mastectomy and radiation therapy from 2007 to 2020 at a single institution. Surgical and oncologic data, complications, and outcomes were compiled.
Results: The chart review identified a total of 30 patients. Mean patient age at the time of surgery was 56 years (42-64). Of the 30 patients, only one required implant removal due to a late infection. The overall success rate was 97% (29/30) in regard to satisfactory breast volume and final position of implant.
Conclusion: The use of a latissimus flap and an ADM are each well-described in the literature regarding implant-based breast reconstruction. Through our experience, these techniques can successfully be combined to provide a superior aesthetic result and to prevent implant malposition during reconstruction of oncologic patients with advanced disease.
