Autologous Breast Reconstruction Using the Immediately Lipofilled Extended Latissimus Dorsi Flap
Association of Breast Surgery ePoster Library. Johns N. 05/15/17; 166301; P023
Neil Johns
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Abstract
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Background–The latissimus dorsi flap is a popular choice for autologous breast reconstruction. To dramatically improve volume, we have devised a method of using the immediately lipofilled extended latissimus dorsi flap to provide a new option for autologous breast reconstruction.
Methods-Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.
Results-71 ELD flaps with immediate lipofilling were performed. 45 patients had immediate reconstructions and the remaining 26 patients had a delayed reconstruction. Median (range) volume of autologous fat injected immediately was 171mls (40-630mls). Contralateral reductions were performed in 25 patients with the median reduction volume 185g (89-683g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection occurred in 11 patients, 5 required IV antibiotics (7%). 5 wound dehiscence occurred, only two of these required resuturing (3%). 10 patients developed signs of fat necrosis (14%). 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with none needing reoperation (4%). BREAST-Q scores faired favorably to other published literature.
Conclusions-Our experience is the largest series to date and shows that the technique is safe, does not compromise flap survival, avoids the requirement for implants, can streamline the reconstructive journey and provides the patient with a high level of satisfaction.
Methods-Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.
Results-71 ELD flaps with immediate lipofilling were performed. 45 patients had immediate reconstructions and the remaining 26 patients had a delayed reconstruction. Median (range) volume of autologous fat injected immediately was 171mls (40-630mls). Contralateral reductions were performed in 25 patients with the median reduction volume 185g (89-683g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection occurred in 11 patients, 5 required IV antibiotics (7%). 5 wound dehiscence occurred, only two of these required resuturing (3%). 10 patients developed signs of fat necrosis (14%). 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with none needing reoperation (4%). BREAST-Q scores faired favorably to other published literature.
Conclusions-Our experience is the largest series to date and shows that the technique is safe, does not compromise flap survival, avoids the requirement for implants, can streamline the reconstructive journey and provides the patient with a high level of satisfaction.
Background–The latissimus dorsi flap is a popular choice for autologous breast reconstruction. To dramatically improve volume, we have devised a method of using the immediately lipofilled extended latissimus dorsi flap to provide a new option for autologous breast reconstruction.
Methods-Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.
Results-71 ELD flaps with immediate lipofilling were performed. 45 patients had immediate reconstructions and the remaining 26 patients had a delayed reconstruction. Median (range) volume of autologous fat injected immediately was 171mls (40-630mls). Contralateral reductions were performed in 25 patients with the median reduction volume 185g (89-683g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection occurred in 11 patients, 5 required IV antibiotics (7%). 5 wound dehiscence occurred, only two of these required resuturing (3%). 10 patients developed signs of fat necrosis (14%). 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with none needing reoperation (4%). BREAST-Q scores faired favorably to other published literature.
Conclusions-Our experience is the largest series to date and shows that the technique is safe, does not compromise flap survival, avoids the requirement for implants, can streamline the reconstructive journey and provides the patient with a high level of satisfaction.
Methods-Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.
Results-71 ELD flaps with immediate lipofilling were performed. 45 patients had immediate reconstructions and the remaining 26 patients had a delayed reconstruction. Median (range) volume of autologous fat injected immediately was 171mls (40-630mls). Contralateral reductions were performed in 25 patients with the median reduction volume 185g (89-683g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection occurred in 11 patients, 5 required IV antibiotics (7%). 5 wound dehiscence occurred, only two of these required resuturing (3%). 10 patients developed signs of fat necrosis (14%). 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with none needing reoperation (4%). BREAST-Q scores faired favorably to other published literature.
Conclusions-Our experience is the largest series to date and shows that the technique is safe, does not compromise flap survival, avoids the requirement for implants, can streamline the reconstructive journey and provides the patient with a high level of satisfaction.
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