by Kim, Jisu; Lee, Hojune; Pyon, Jai-Kyong; Mun, Goo-Hyun;
Bang, Sa Ik; Jeon, Byung-Joon; Lee, Kyeong-Tae
Plastic and Reconstructive Surgery: September
2022 - Volume 150 - Issue 3 - p 644e-654e
Background:
The latissimus dorsi muscle originates from the lower
thoracic spine with broad attachment and plays a subsidiary role in spinal
postural stability. The authors investigated whether harvesting unilateral
latissimus dorsi muscle for breast reconstruction could influence spinal
posture in the long term.
Methods:
Patients who underwent immediate unilateral breast
reconstruction between 2002 and 2010 were reviewed. They were grouped according
to reconstruction methods: latissimus dorsi muscle flap and tissue expander/implant.
The Cobb angle was assessed twice at each of five different time points
(preoperatively and 2, 4, 6, and 8 years postoperatively) by an independent
physician blinded to the reconstruction modality. Postoperative scoliosis was
defined as a mean Cobb angle greater than 10 degrees at 8 years
postoperatively. The trends of changes in Cobb angle over time and the rates of
postoperative scoliosis were compared between reconstruction methods.
Results:
In total, 153 women were analyzed, including 102 using
latissimus dorsi muscle flap and 51 using tissue expander/implant, with a
median follow-up of 103 months. The latissimus dorsi flap group showed enhanced
trends of increasing postoperative Cobb angles as compared with the tissue
expander/implant group, and the difference remained significant after adjusting
for other variables (p = 0.001). The rate of postoperative scoliosis was
significantly higher in the latissimus dorsi flap group than in the control
group (p = 0.029). Multivariable analyses revealed that use of the
latissimus dorsi flap was associated with a significantly increased rate of
postoperative scoliosis.
Conclusion:
Unilateral latissimus dorsi muscle flap harvest for breast
reconstruction might be associated with changes in spinal posture in the long
term.
