Can nipple-sparing mastectomy and immediate breast reconstruction with modified extended latissimus dorsi muscular flap improve the cosmetic and functional outcome among patients with breast carcinoma?

BACKGROUND: Nipple-areola complex (NAC) preservation is a new revolution in breast cancer surgery and breast reconstruction, if reliability and safety are considered. The latissimus dorsi muscular flap is a versatile flap that is gaining renewed popularity for immediate breast reconstruction with development of modifications. We are introducing nipple-sparing mastectomy (NSM) for Egyptian patients with breast carcinoma and reporting our results with a new modification of the extended latissimus dorsi muscular flap.

METHODS: Between July 2005 and August 2006; forty-one patients with stage I to III breast carcinoma had NSM and immediate breast reconstruction. We performed a new modification to the extended latissimus dorsi muscular flap that allowed us to obtain enough autologous tissue to reconstruct the breast without implant or back incision. The postoperative aesthetic results with specific view of the preserved NAC were evaluated.

RESULTS: We applied both an objective and subjective aesthetic result to our monitoring. Aesthetic grading results of breast reconstruction were as follows: excellent in 31, good in 6, fair in 2, poor in 2. Both reconstructed breast and donor site complications were minor. Patients are followed for a median follow-up of 7.9 months (range: 4-11 months). In this short period of follow-up, no local recurrence or distant failure has been observed.

CONCLUSIONS: Nipple-sparing mastectomy with immediate breast reconstruction using modified extended latissimus dorsi muscular flap allows single-stage, totally autologous reconstruction with a satisfactory aesthetic result, low morbidity, and good quality of life.