Outcomes of Fat-Augmented Latissimus Dorsi (FALD) Flap Versus Implant-Based Latissimus Dorsi Flap for Delayed Post-radiation Breast Reconstruction

• Published in: Aesthetic plastic surgery Vol. 42; no. 3; pp. 692 - 701
• Main Authors: Demiri, Efterpi C., Dionyssiou, Dimitrios D., Tsimponis, Antonios, Goula, Christina-Olga, Pavlidis, Leonidas C., Spyropoulou, Georgia-Alexandra
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2018; Springer Nature B.V
• Subjects: Adipose Tissue - transplantation; Adult; Aged; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Chi-Square Distribution; Cohort Studies; Databases, Factual; Esthetics; Female; Follow-Up Studies; Free Tissue Flaps - transplantation; Graft Survival; Humans; Mammaplasty - methods; Mastectomy; Mastectomy - methods; Medicine; Medicine & Public Health; Middle Aged; Original Article; Otorhinolaryngology; Plastic Surgery; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Risk Assessment; Shoulder; Statistics, Nonparametric; Superficial Back Muscles - transplantation; Time Factors; Time-to-Treatment; Transplantation, Autologous - methods; Treatment Outcome; Post-radiation delayed reconstruction; Fat-augmented latissimus dorsi flap; Complications; Autologous breast reconstruction
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-018-1081-6

Background Although free abdominal flaps constitute the gold standard in post-radiation delayed breast reconstruction, latissimus dorsi-based methods offer alternative reconstructive options. This retrospective study aims to compare outcomes of delayed breast reconstruction using the fat-augmented latissimus dorsi (FALD) autologous reconstruction and the latissimus dorsi-plus-implant reconstruction in irradiated women. Methods We reviewed the files of 47 post-mastectomy irradiated patients (aged 29–73 years), who underwent delayed latissimus dorsi-based breast reconstruction between 2010 and 2016. Twenty-three patients (Group A) had an extended FALD flap and twenty-four patients (Group B) an implant-based latissimus dorsi reconstruction. Patients’ age, BMI, pregnancies, volume of injected fat, implant size, postoperative complications, and secondary surgical procedures were recorded and analyzed. Results Age, BMI, pregnancies, and donor-site complications were similar in both groups ( p  > 0.05). Mean fat volume injected initially was 254 cc (ranged 130–380 cc/session); mean implant volume was 323 cc (ranged 225–420 cc). Breast complications were significantly fewer in Group A (one wound dehiscence, two oily cysts) compared to Group B (three cases with wound dehiscence, two extrusions, thirteen severe capsular contractions). Non-statistically significant difference was documented for secondary procedures between groups; although the mean number of additional surgeries/patient was higher in Group A, they referred to secondary lipofilling, whereas in Group B they were revision surgeries for complications. Conclusions The FALD flap constitutes an alternative method for delayed autologous reconstruction after post-mastectomy irradiation, avoiding implant-related complications. Although additional fat graft sessions might be required, it provides an ideal autogenous reconstructive option for thin nulliparous women, with a small opposite breast and adequate fat donor sites. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .