Immediate Breast Reconstruction Using an Expanded Latissimus Dorsal Musculocutaneous Flap Without Body Position Change.

Background: Breast reconstruction using expanded latissimus dorsal musculocutaneous flap (eLDMC flap) is known for excellent outcome; however, intraoperative change in body position to assess cosmesis prolongs operative time. Here, we present the results and the strengths of immediate breast reconstruction with an eLDMC flap without body position change that we have developed. Methods: Two hundred twenty-three patients who underwent total mastectomy followed by immediate breast reconstruction using eLDMC flaps between November 2010 and December 2018 at Wakayama Medical University Hospital were analyzed for operative times, complications, conformity, local recurrence, and distant metastasis. Forty-eight patients without reconstruction during the same period were also analyzed. Results: The median time of follow-up after operation was 57 months (0 - 121 months). The mean operation time was 183.6 min (115 - 291 min), which was approximately 4 - 6 h shorter than the reported technique with body position changes. Complications occurred in 130 patients (58.3%) and there was seroma in 103 patients (79.2%). There was local recurrence in 12 cases (5.4%), and distant metastasis occurred in six cases (2.7%). The recurrence rate was equivalent to that of previous reports. A total of 208 patients (93.3%) were evaluated to be excellent or good. Conclusion: Immediate breast reconstruction with an eLDMC flap without body position change is a safe, quick, and sufficient surgical procedure. Our surgical method achieves shorter operation times without compromising cosmetic appearance or increasing the complications and recurrence rate.