Should bilateral latissimus dorsi myocutaneous flap be used as a first-line procedure for breast reconstruction?

Shayna L. Showalter M.D., Neil Moudgill M.D., Eric Hager M.D., Timothy K. Williams M.D., Kristin Brill M.D., Anne Rosenberg M.D., Steven E. Copit M.D.

Department of Surgery, Division of Plastic and Reconstructive Surgery, Thomas Jefferson University, Philadelphia, PA

Purpose:  To analyze a series of bilateral latissimus dorsi myocutaneous flap (LDMF) breast reconstructions performed by a single surgeon (S.C.) and to provide data supporting the use of LDMF as a first-line procedure for breast reconstruction.

Methods:  We reviewed outcomes of a prospective cohort of 121 patients who underwent bilateral mastectomy followed by bilateral LDMF.  All reconstructions were performed by a single surgeon between February 2000 and August 2007.  One-hundred and eight (89.3%) of the LDMF reconstructions were immediate and 13 (10.7%) delayed.  End points included average length of stay (LOS),  total operative time (mastectomy and LDMF reconstruction), operative time for LDMF reconstruction alone, estimated blood loss (EBL), body mass index (BMI), occurrence of post-operative hematoma or seroma, and incidence of necrosis or flap loss.

Results:  Mean age of the patient group at the time of operation was 47.4y. (range 28y - 72 y).  Mean BMI was 23.9.  Mean total operative time was 7.35 h (range 4.65h - 10.0h).   Mean time of LDMF reconstruction was 5.53h (range 3.0h - 7.45h).  Mean EBL was 300 cc. Three (2.5%) patients received a blood transfusion of 1 unit.  Mean LOS was 3.3 days.   Forty-two patients (34.7%) developed a donor site seroma, and required an average of 2.7 aspirations.   Six patients (5.0 %) developed a donor site hematoma that required reoperation.  There was no incidence of flap necrosis or flap loss.

Conclusion:  These data, representing a large consecutive series of bilateral LDMF as a primary procedure for breast reconstruction, validate the approach as one that provides excellent cosmetic results with low morbidity.  The technique is suggested as one to be considered routinely for patients undergoing bilateral breast reconstruction.