Immediate latissimus dorsi/prosthetic breast reconstruction following salvage mastectomy after failed lumpectomy/irradiation.

BACKGROUND: Few reports have critically evaluated outcomes following immediate latissimus dorsi/prosthetic reconstruction in the setting of prior irradiation. The primary objective of this study was thus to evaluate the incidence of perioperative complications, capsular contracture severity, and overall aesthetic results following immediate latissimus dorsi/implant reconstruction in patients undergoing salvage mastectomy for failed breast conservation therapy.

METHODS: A review of all immediate, combined latissimus dorsi/prosthetic breast reconstructions performed at Memorial Sloan-Kettering Cancer Center from July of 1996 to December of 2005 was performed. Fifty-seven patients who underwent reconstruction following salvage mastectomy for local breast cancer were identified. Aesthetic results and capsular contracture severity were subsequently evaluated in a cohort of 30 patients with a minimum follow-up of 1 year.

RESULTS: Overall flap survival was 100 percent. Minor and major perioperative complications occurred in 22.8 and 7.0 percent of patients, respectively. At a mean follow-up of 4.1 years (range, 1 to 10 years), 70 percent of patients had a very good to excellent aesthetic result. Overall cosmesis was higher in patients who had two-stage compared with single-stage reconstruction (p = 0.045). Seventeen percent of reconstructions (five of 30) had a Baker grade III capsular contracture; there were no grade IV contractures.

CONCLUSIONS: It appears that the concurrent use of the latissimus dorsi flap can facilitate implant-based reconstruction in patients undergoing salvage mastectomy after failed lumpectomy and irradiation. Major complications resulting in reconstructive failure were few. In the majority of patients, combined latissimus dorsi/implant reconstruction resulted in very good to excellent aesthetic results and an acceptable rate of capsular contracture.