25.0: Thursday, March 17, 2005

Immediate Latissimus Dorsi Myocutaneous Reconstruction in Patients Undergoing Breast Conservation Therapy

Melissa A. Crosby, MD, Jeffrey M. Kenkel, MD, Susan J. Hoover, MD, George Peters, MD, and Rod J. Rohrich, MD.

Introduction: Breast conservation therapy (BCT) has evolved as an oncologically equivalent approach to mastectomy in select patients with early breast cancer. Immediate breast reconstruction with autologous tissue provides a viable option for improved cosmetic outcome. We report our experience with BCT followed by immediate latissimus dorsi myocutaneous flap (LDMF) reconstruction.

Methods: Twenty-four patients underwent BCT with immediate LDMF reconstruction from 1996-2000. Medical records were reviewed for pathologic staging and tumor recurrence. A survey was conducted to determine patient satisfaction based on symmetry, nipple position/sensation, and axillary fullness. Donor site morbidity with respect to pain, numbness, limitation of activity and scar deformity was assessed.

Results: All patients had early stage breast cancer. The predominant pathology was infiltrating ductal carcinoma (75%). With a median follow-up of 48 months, 4 patients required completion mastectomies. Patient satisfaction was high and 95% considered their operation a valid alternative to mastectomy. Donor site morbidity was minimal and all patients reported good to excellent nipple sensation. No interference with follow-up mammography was seen. LDMF tolerance to radiation was good.

Conclusion: BCT with immediate LDMF reconstruction provides a viable alternative for the management of breast cancer in patients who express a desire to preserve breast tissue and cosmesis.