Background: Reconstruction of partial breast defects in low-volume, nonptotic
breasts can be challenging. The authors hypothesized that use of the latissimus
dorsi flap in partial breast reconstruction is safe and associated with low
complication and high patient satisfaction rates. Methods: All patients who underwent breast-conserving therapy and
latissimus dorsi flap reconstruction from January 1, 2006, to December 31,
2016, were identified in a prospectively maintained database. Patient
demographics, tumor characteristics, and complications were recorded.
Patient-reported outcomes were assessed with the BREAST-Q breast-conserving
therapy module. A group of plastic surgeons and laypersons used a five-point
Likert scale to evaluate aesthetic outcomes in representative patients.
Results: Forty-seven patients met the inclusion criteria. Median follow-up was
5.4 years. Most patients (93.6 percent) underwent immediate reconstruction. The
mean resection volume was 219.5 cc (range, 70 to 877 cc). The overall complication
rate was 8.5 percent. Grade 2 or 3 ptosis (OR, 1.21; 95 percent CI, 1.0 to
1.46; p = 0.03), smoking (OR, 13.1; 95 percent CI, 1.2 to 143.2; p = 0.03), and
multicentric tumor (OR, 1.23; 95 percent CI, 1.04 to 1.64; p = 0.02) were
associated with a higher complication rate. Ductal carcinoma in situ was
associated with reoperation for positive margins (OR, 14.4; 95 percent CI, 2.1
to 100; p = 0.009). Of particular interest, patient-reported outcomes were
favorable, with the highest rated domains being Satisfaction with Breasts (61;
interquartile range, 37 to 77), Psychosocial Well-being (87; interquartile
range, 63 to 100), and Physical Well-being (87; interquartile range, 81 to
100). The median aesthetic score was 4 (of 5).
Conclusions: This is the first study to date using the
BREAST-Q to assess patient-reported outcomes associated with the latissimus
dorsi flap for partial breast reconstruction. The flap is safe and effective
for reconstruction in the setting of breast-conserving therapy, providing aesthetically
pleasing results with high patient satisfaction. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, IV.
