BACKGROUND: The association the thoracodorsal muscular flap with a thoracic fascio-cutaneous extension results in a large flap, that allowed to cover the mastectomy residual skin defect. The purpose of this study is to share 11 year experience with a new concept in autologous breast reconstruction using a deepithelialized thoracodorsal skin flap pedicle with the latissimus dorsi muscle as vector.
METHODS: A retrospective study of 247 operated patients from 1999 to 2009 was performed. Parameters of interest included age, body mass index, smoking, radiation and chemotherapy histories, breast size, flap dimensions, operative time, breast tissue expansion and complication rates. The thoracodorsal flap design under an ellipse shape extends from near the mid dorsal line extended up to the mid-infra-mammary line with maximal width at the mid axillary line. The deepithelialized fascio-cutaneous extension is lumped together with the latissimus dorsi as its vehicle and blood supply pedicle, together are brought to the neo-mammary previous dissected skin area. Gradual as a tissue expansion the breast shape and projection are restored.
RESULTS: Immediate and delayed breast reconstructions were done in 14.5% and 85.5%, respectively. Bilateral breast reconstruction was done in 9% of the patients. Implants were not used for reconstruction purposes in any of the 77% of the patients received breast radiotherapy. The average operative time was 2 hours and 20 minutes. Expansion of non irradiated breast skin occurred over a three months period, whereas that of irradiated skin took an average of five months following delayed reconstruction. The complication rate was 11.4%. No total flap loss was reported. The seroma rate was 7% after the drains had been removed. The mean hospital stay was 3 days. Contra lateral breast remodeling was performed in 92% of the cases and fat grafting in 14% of the cases. With an average follow-up of 4 years, patient satisfaction was rated high by the patients.
CONCLUSIONS: The thoracodorsal flap is a safe and reliable surgical option for autologous breast reconstruction. Its main advantages achieving large breast volumes circumventing the use of prosthetic material, avoiding the patch look on the reconstructive breast, achieving tissue expansion, while insuring acceptable donor site morbidity.
Keywords: Breast/surgery. Mammaplasty/methods. Surgical flaps.