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Factors Associated with Salvage Latissimus Breast Reconstruction
Michael Subichin MD
Douglas Wagner MD
Summa Health System (NEOMED)
2015-03-14
Presenter: Michael Subichin MD
Affidavit:
Affadavit: I attest that Michael Subichin, MD performed 100% of the data collection, analysis, and manuscript preparation for this submission. He prepared the entire Powerpoint presentation. He and I jointly conceived of the project.
Director Name: Douglas Wagner, MD
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose/Objective
The utility of the latissimus dorsi myocutaneous flap in salvage breast reconstruction has been well substantiated. Salvage breast reconstruction is defined as a secondary procedure when previous reconstruction is inadequate. We sought to determine the patient characteristics and success of latissimus salvage reconstruction.
Methods
We performed a review of latissimus flaps by a single surgeon over a 24 year period. 35 patients with salvage latissimus reconstruction were identified. We collected initial reconstruction data, the presence of radiation therapy, patient demographics, and the outcome of the salvage procedure. Chi square was used for all analysis.
Results
All 35 patients successfully completed breast reconstruction. Additionally, salvage patients underwent few additional reconstructive procedures with a mean of 0.5 additional surgeries (range 0-3).
24 patients (59%) had previous tissue expansion, 6 patients (17%) had previous abdominal flap reconstruction, and 5 patients (14%) had previous direct to implant reconstruction. Overall, patients were more likely to have had tissue expansion (p<0.01).
Radiation was the most common indication for salvage procedure (p<0.05). This was seen in 18 patients (51%), while ischemia was seen in 13 patients (37%), and infection was observed in 4 patients (11%). Additionally, 8 patients (23%) were tobacco users at the time of surgery.
Discussion/Conclusion
Our experience shows that there is a high success rate of salvage latissimus flap as a definitive reconstructive tool. Patients most frequently require salvage reconstruction if they undergo tissue expansion, require radiation, or are active tobacco users. These factors should be considered when evaluating breast reconstruction patients.
