Autologous latissimus breast reconstruction in association with the abdominal advancement flap: a new refinement in breast reconstruction.

The authors present a technique that combines autologous latissimus breast reconstruction with the thoracoabdominal advancement flap. The aim is to reduce the patched effect of the dorsal skin paddle and to minimize scars on the reconstructed breast. Fifty patients underwent delayed breast reconstruction using this technique from March 1993 through May 1997. Of these 50 patients, 42 (84%) had unilateral reconstruction and 8 (16%) had two-stage bilateral reconstruction at 5- to 7-month intervals. Forty-one patients (82%) had previously received radiotherapy of the thoracic wall. The abdominal advancement flap allowed subtotal burial of the latissimus dorsi flap (preserving only the future nipple-areolar complex) in 40 patients (80%) and total burial in 10 patients (20%). Reduction surgery was done on the other breast in 17 patients (34%) and mastopexy in 3 patients (6%). In 8 patients (16%) the opposite breast required mastectomy and reconstruction using an autologous latissimus dorsi flap. The aesthetic results, as evaluated by two plastic surgeons on the basis of pre- and postoperative photographs, were rated as very good in 44 patients (88%), good in 5 patients (10%), and poor in 1 patient (2%). No result was considered bad. The main drawback was dorsal seroma, which occurred in 68% of patients but was managed easily by repeated aspiration. Subtotal or total burial of the skin paddle through the original association of the autologous latissimus dorsi flap with the abdominal advancement flap gives markedly improved results by reducing the scars on the reconstructed breast, avoiding the patched effect, and providing a supple breast with a natural ptotic shape.