Skip to main content
SpringerLink
Log in
Book cover

Breast Reconstruction pp 717–725Cite as

Autologous Breast Reconstruction with the Denervated, Extended Latissimus Dorsi Musculocutaneous Flap

  • Chapter

  • 193 Accesses

Abstract

Breast reconstruction with latissimus dorsi (LD) musculocutaneous flap allows to recreate a symmetrical breast mound with the contralateral side. Procedure of extended LD flap avoids need for implant also in moderately-sized breasts. The complication rate and donor site morbidity are low and patient satisfaction with this procedure is high. The twitching transposed LD muscle causes significant discomfort for the patients and thus diminishes the satisfaction after the surgery. The muscular contraction deformities can be treated noninvasively with botulin toxin injections or surgically by excising at least 1 cm segment of the most proximal aspect the thoracodorsal nerve. Autologous breast reconstruction with the pedicled, extended, denervated LD flap is a well-established surgical technique with high rate of long-term good aesthetic outcomes with the natural tissue consistency. The routine division of the thoracodorsal nerve will reduce the complication of troublesome breast movements.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Trabulsy PP, Anthony JP, Mathes SJ (1994) Changing trends in postmastectomy breast reconstruction: a 13-year experience. Plast Reconstr Surg 93(7):1418–1427

    Article  PubMed  CAS  Google Scholar 

  2. Menke H, Erkens M, Olbrisch RR (2001) Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg 47(2):107–114

    Article  PubMed  CAS  Google Scholar 

  3. Hoover SJ, Kenkel JM (2002) Breast cancer, cancer prevention, and breast reconstruction. Select Read Plast Surg 30:19

    Google Scholar 

  4. Sternberg EG, Perdikis G, McLaughlin SA, Terkonda SP, Waldorf JC (2006) Latissimus dorsi flap remains an excellent choice for breast reconstruction. Ann Plast Surg 56(1):31–35

    Article  PubMed  CAS  Google Scholar 

  5. Rykala J, Szychta P, Kruk-Jeromin J (2011) Delayed two-stage breast reconstruction with implants: the authors’ recent experience. Can J Plast Surg 19(3):88–92

    PubMed  PubMed Central  Google Scholar 

  6. Van Landuyt K, Hamdi M, Blondeel P, Monstrey S (2004) Autologous breast augmentation by pedicled perforator flaps. Ann Plast Surg 53(4):322–327

    Article  PubMed  Google Scholar 

  7. Blondeel PN, Vanderstraeten GG, Monstrey SJ, Van Landuyt K, Tonnard P, Lysens R, Boeck WD, Matton G (1997) The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 50(5):322–330

    Article  PubMed  CAS  Google Scholar 

  8. Patel NP, Meeteren J, Pedersen J (2012) A new dimension robotic reconstruction in plastic surgery. J Robot Surg 6(1):77–80

    Article  Google Scholar 

  9. Tansini I (1906) Sopra il mino nuovo processo di amputazion della mammella. Gazz Med Ital 57:141

    Google Scholar 

  10. Mühlbauer W, Olbrisch RR (1977) The latissimus dorsi myocutaneous flap for breast reconstruction. Chir Plast 4:27–34

    Article  Google Scholar 

  11. Bostwick J III, Vasconez LO, Jurkiewicz MJ (1978) Breast reconstruction after radical mastectomy. Plast Reconstr Surg 61(5):682–693

    Article  PubMed  Google Scholar 

  12. Figus A, Mazzocchi M, Dessy LA, Curinga G, Scuderi N (2009) Treatment of muscular contraction deformities with botulinum toxin type a after latissimus dorsi flap and sub-pectoral implant breast reconstruction. J Plast Reconstr Aesthet Surg 62(7):869–875

    Article  PubMed  Google Scholar 

  13. Watanabe K, Kiyokawa K, Rikimaru H, Koga N, Yamaki K, Saga T (2010) Anatomical study of latissimus dorsi musculocutaneous flap vascular distribution. J Plast Reconstr Aesthet Surg 63(7):1091–1098

    Article  PubMed  Google Scholar 

  14. Denewer A, Setit A, Hussein O, Farouk O (2008) Skin-sparing mastectomy with immediate breast reconstruction by a new modification of extended latissimus dorsi myocutaneous flap. World J Surg 32(12):2586–2592

    Article  PubMed  Google Scholar 

  15. Bonomi S, Salval A, Sorbi F, Settembrini F (2012) To sever or not the thoracodorsal nerve in latissimus dorsi flap breast reconstruction. Plast Reconstr Surg 130(2):367e–368e

    Article  PubMed  CAS  Google Scholar 

  16. Ducic I, Spear SL, Cuoco F, Hannan C (2005) Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis. Ann Plast Surg 55(6):559–564

    Article  PubMed  CAS  Google Scholar 

  17. Ngan PG, Jayagopal S, George EN, McGeorge D, Juma A (2007) Preference for donor site scar orientation in pedicled latissimus dorsi breast reconstruction. Eur J Plast Surg 30(4):189–194

    Article  Google Scholar 

  18. Hammond DC, Simon AM, Khuthaila DK, Hoberman L, Sohn S (2007) Latissimus dorsi flap salvage of the partially failed TRAM flap breast reconstruction. Plast Reconstr Surg 120(2):382–389

    Article  PubMed  CAS  Google Scholar 

  19. Button J, Scott J, Taghizadeh R, Weiler-Mithoff E, Hart AM (2010) Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. J Plast Reconstr Aesthet Surg 63(9):1505–1512

    Article  PubMed  CAS  Google Scholar 

  20. Halperin TJ, Fox SE, Caterson SA, Slavin SA, Morris DJ (2007) Delayed division of the thoracodorsal nerve: a useful adjunct in breast reconstruction. Ann Plast Surg 59(1):23–25

    Article  PubMed  CAS  Google Scholar 

  21. Spear SL, Hess CL (2006) Delayed postmastectomy reconstruction: latissimus dorsi flap technique. In: Mathes SJ, Hentz VR (eds) Plastic surgery, 2nd edn. Saunders Elsevier, Philadelphia, pp 1023–1036

    Google Scholar 

  22. Spear SL, Saba AA (2006) Immediate postmastectomy reconstruction: latissimus dorsi flap technique. In: Mathes SJ, Hentz VR (eds) Plastic surgery, 2nd edn. Saunders Elsevier, Philadelphia, pp 819–834

    Google Scholar 

  23. Park SY, Yoo WG (2014) Differential activation of parts of the latissimus dorsi with various isometric shoulder exercises. J Electromyogr Kinesiol 24(2):253–257

    Article  PubMed  Google Scholar 

  24. Yano K, Hosokawa K, Takagi S, Nakai K, Kubo T (2002) Breast reconstruction using the sensate latissimus dorsi musculocutaneous flap. Plast Reconstr Surg 109(6):1897–1902

    Article  PubMed  Google Scholar 

  25. McGregor IA, Morgan G (1973) Axial and random pattern flaps. Br J Plast Surg 26(3):202–213

    Article  PubMed  CAS  Google Scholar 

  26. Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40(2):113–141

    Article  PubMed  CAS  Google Scholar 

  27. Nakajima H, Maruyama Y, Koda E (1981) The definition of vascular territories with prostaglandin E1-the anterior chest, abdomen and thigh-inguinal region. Br J Plast Surg 34(3):258–263

    Article  PubMed  CAS  Google Scholar 

  28. Callegari PR, Taylor GI, Caddy CM, Minabe T (1992) An anatomical review of the delay phenomenon: experimental studies. Plast Reconstr Surg 89(3):397–407

    Article  PubMed  CAS  Google Scholar 

  29. Taylor GI, Corlette RJ, Caddy CM, Zelt RG (1992) An anatomical review of the delay phenomenon: clinical applications. Plast Reconstr Surg 89(3):408–416

    Article  PubMed  CAS  Google Scholar 

  30. Mathes SJ, Nahai F (1981) Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 67(2):177–187

    Article  PubMed  CAS  Google Scholar 

  31. Schaverien M, Wong C, Bailey S, Saint-Cyr M (2010) Thoracodorsal artery perforator flap and Latissimus dorsi myocutaneous flap – anatomical study of the constant skin paddle perforator locations. J Plast Reconstr Aesthet Surg 63(12):2123–2127

    Article  PubMed  Google Scholar 

  32. Agaoglu G, Erol OO (2009) Delayed breast reconstruction with latissimus dorsi flap. Aesthetic Plast Surg 33(3):413–420

    Article  PubMed  Google Scholar 

  33. Hammond DC (2007) Latissimus dorsi breast reconstruction. Clin Plast Surg 34(1):75–82

    Article  PubMed  Google Scholar 

  34. Bailey SH, Saint-Cyr M, Oni G, Wong C, Maia M, Nguyen V, Pessa JE, Colohan S, Rohrich RJ, Mojallal A (2011) The low transverse extended latissimus dorsi flap based on fat compartments of the back for breast reconstruction: anatomical study and clinical results. Plast Reconstr Surg 128(5):382e–394e

    Article  PubMed  Google Scholar 

  35. Barton FE Jr, Spicer TE, Byrd HS (1983) Head and neck reconstruction with the latissimus dorsi myocutaneous flap: anatomic observations and report of 60 cases. Plast Reconstr Surg 71:199–204

    Article  PubMed  Google Scholar 

  36. Blondeel PN, Beyens G, Verhaeghe R, Van Landuyt K, Tonnard P, Monstrey SJ, Matton G (1998) Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51(3):202–209

    Article  PubMed  CAS  Google Scholar 

  37. Hammond DC (2009) Latissimus dorsi flap breast reconstruction. Plast Reconstr Surg 124(4):1055–1063

    Article  PubMed  CAS  Google Scholar 

  38. Szychta P, Butterworth M, Dixon M, Kulkarni D, Stewart K, Raine C (2013) Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap. Breast 22(5):667–672

    Article  PubMed  Google Scholar 

  39. Sakai S, Ando K, Natori M, Sakai S (2005) Cosmetic reconstruction after resection of breast cancer: use of the ELD-MC flap and EVRAM flap. Int J Clin Oncol 10(5):298–303

    Article  PubMed  Google Scholar 

  40. Heitmann C, Pelzer M, Kuentscher M, Menke H, Germann G (2003) The extended latissimus dorsi flap revisited. Plast Reconstr Surg 111(5):1697–1701

    Article  PubMed  Google Scholar 

  41. Chang DW, Youssef A, Cha S, Reece GP (2002) Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg 110(3):751–759

    Article  PubMed  Google Scholar 

  42. Micali E, Carramaschi FR (2001) Extended V-Y latissimus dorsi musculocutaneous flap for anterior chest wall reconstruction. Plast Reconstr Surg 107(6):1382–1390

    Article  PubMed  CAS  Google Scholar 

  43. Hankins CL, Friedman J (2008) A 7-year experience in utilizing the latissimus dorsi myocutaneous flap for bilateral breast reconstruction. Ann Plast Surg 60(2):134–140

    Article  PubMed  CAS  Google Scholar 

  44. Smith BK, Cohen BE, Biggs TM, Suber J (2001) Simultaneous bilateral breast reconstruction using latissimus dorsi myocutaneous flaps: a retrospective review of an institutional experience. Plast Reconstr Surg 108(5):1174–1181

    Article  PubMed  CAS  Google Scholar 

  45. Rantanen J, Ranne J, Hurme T, Kalimo H (1995) Denervated segments of injured skeletal muscle fibers are reinnervated by newly formed neuromuscular junctions. J Neuropathol Exp Neurol 54(2):188–194

    Article  PubMed  CAS  Google Scholar 

  46. Cohen BE, Cronin ED (1984) Breast reconstruction with the latissimus dorsi musculocutaneous flap. Clin Plast Surg 11(2):287–302

    PubMed  CAS  Google Scholar 

  47. Maxwell GP (1981) Latissimus dorsi breast reconstruction: an aesthetic assessment. Clin Plast Surg 8(2):373–387

    PubMed  CAS  Google Scholar 

  48. Vasconez LO (2007) Endoscopic latissimus dorsi flap harvesting. Am J Surg 194(2):170–171

    Article  PubMed  Google Scholar 

  49. Bittar SM, Sisto J, Gill K (2012) Single-stage breast reconstruction with the anterior approach latissimus dorsi flap and permanent implants. Plast Reconstr Surg 129(5):1062–1070

    Article  PubMed  CAS  Google Scholar 

  50. Hammond DC (2011) Discussion: the significance of latissimus dorsi flap innervation in delayed breast reconstruction: a prospective randomized study-magnetic resonance imaging and histologic findings. Plast Reconstr Surg 128(6):646e–648e

    Article  PubMed  Google Scholar 

  51. Paolini G, Longo B, Laporta R, Sorotos M, Amoroso M, Santanelli F (2013) Permanent latissimus dorsi muscle denervation in breast reconstruction. Ann Plast Surg 71(6):639–642

    Article  PubMed  CAS  Google Scholar 

  52. Thomson HJ, Potter S, Greenwood RJ, Bahl A, Barker J, Cawthorn SJ, Winters ZE (2008) A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 15(4):1081–1091

    Article  PubMed  Google Scholar 

  53. Munhoz AM, Montag E, Fels KW, Arruda EG, Sturtz GP, Aldrighi C, Gemperli R, Ferreira MC (2005) Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. Plast Reconstr Surg 116(3):741–752

    Article  PubMed  CAS  Google Scholar 

  54. Bredella MA, Tirman PF, Fritz RC, Wischer TK, Stork A, Genant HK (1999) Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skeletal Radiol 28(10):567–572

    Article  PubMed  CAS  Google Scholar 

  55. Kauhanen MS, Salmi AM, von Boguslawsky EK, Leivo IV, Asko-Seljavaara SL (1998) Muscle fiber diameter and muscle type distribution following free microvascular muscle transfer: a prospective study. Microsurgery 18(2):137–144

    Article  PubMed  CAS  Google Scholar 

  56. Szychta P, Raine C, Butterworth M, Witmanowski H, Zadrozny M, Rykala J (2014) Preoperative implant selection for two stage breast reconstruction with 3D imaging. Comput Biol Med 44:136–143

    Article  PubMed  Google Scholar 

  57. McKeown DJ, Hogg FJ, Brown IM, Walker MJ, Scott JR, Weiler-Mithoff EM (2009) The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome. J Plast Reconstr Aesthet Surg 62(4):488–493

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology and Breast Diseases, Polish Mother’s Memorial Hospital Research Institute, ul. Rzgowska 281/289, Lodz, 93-338, Poland

    Pawel Szychta M.D., Ph.D., D.Sc. & Marek Zadrozny M.D., Ph.D., D.Sc.

  2. Department of Plastic and Reconstructive Surgery, St John’s University Hospital, Howden Road West, Livingston, West Lothian, EH54 6PP, UK

    Pawel Szychta M.D., Ph.D., D.Sc., Kenneth Stewart MB, ChB, M.D., Mark Butterworth MB, ChB & Cameron Raine MB, ChB, M.D.

Authors
  1. Pawel Szychta M.D., Ph.D., D.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth Stewart MB, ChB, M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marek Zadrozny M.D., Ph.D., D.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Butterworth MB, ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cameron Raine MB, ChB, M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pawel Szychta M.D., Ph.D., D.Sc. .

Editor information

Editors and Affiliations

  1. Tustin, California, USA

    Melvin A. Shiffman

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Szychta, P., Stewart, K., Zadrozny, M., Butterworth, M., Raine, C. (2016). Autologous Breast Reconstruction with the Denervated, Extended Latissimus Dorsi Musculocutaneous Flap. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_68

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18726-6_68

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18725-9

  • Online ISBN: 978-3-319-18726-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation