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Muscle-Only Latissimus Dorsi Flap for Salvage Implant-Based Reconstruction in Irradiated Breasts
Ashraf A. Patel, BS1, Mallory A. Rowley, BA1, Prashant K. Upadhyaya, MD2 1College of Medicine, SUNY Upstate Medical University, Syracuse, NY 2Department of Surgery, SUNY Upstate Medical University, Syracuse, NY

Background: Chest wall radiation for breast cancer is often associated with reconstruction-related complications including infection or wound dehiscence which may lead to reconstruction failure. The traditional approach to these complications involves removing the prosthesis followed by staged salvage reconstruction, often times with a latissimus-dorsi (LD) myocutaneous flap. We describe our treatment protocol utilizing the muscle-only LD flap to salvage the breast reconstruction in a single surgery. We believe that it may lead to a better cosmetic outcome as the mastectomy skin flap is preserved and avoids multiple procedures.

Methods: A retrospective chart review of patients who underwent muscle-only LD flap procedures (March 2016 October 2019) to salvage implant-based reconstruction (IBR) was performed. Demographic, perioperative, and postoperative complication data following the flap procedure was collected and described using means, standard deviations, and frequencies.

Results: Fourteen patients (14 breasts) met inclusion criteria, and a majority had undergone postmastectomy radiation therapy (PMRT) (78.57%). Most patients underwent salvage after stage two of IBR (92.86%), with wound dehiscence cited as the most common indication for salvage (78.57%). Following salvage reconstruction, one patient had a complication (7.1%), a minor infection treated with oral antibiotics. One patient (7.1%) pursued revisionary surgery: an implant exchange to downsize her implant. Follow up time was 946.1 days.

Conclusion: Complications following muscle-only LD flap procedures to salvage IBR are minimal, likely owing to the transplantation of autologous, vascularized muscle with inherent infection-fighting properties. In contrast to the myocutaneous LD flap, the muscle-only technique preserves the mastectomy skin flaps, allowing for improved cosmesis. By undergoing immediate salvage, the patient also undergoes fewer surgeries and completes reconstruction in a shorter time frame. This approach could be a useful additional technique in dealing with complications, especially in breasts with history of radiation or multiple prior surgeries.

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