Single-Stage Latissimus-Implant Breast Reconstruction Is Safe and Reliable: A Single Surgeon Series of 207 Flaps.

Abstract

The latissimus dorsi flap (LDF) is a historical workhorse and contemporary salvage mainstay for breast reconstruction. There is still debate regarding timing and staging, with some authors advocating for staged reconstruction using tissue expanders. We present a single-surgeon experience with LDF breast reconstruction and compare the results of single-stage reconstruction versus staged approaches. Patients undergoing LDF breast reconstruction from 2008 to 2021 with a single surgeon (R.S.) were included. Charts were reviewed for demographics, indications, number and type of planned stages, and outcomes. Acute and chronic complications and revisions were compared between indication and staging groups. A total of 156 patients underwent LDF breast reconstruction, of which 111 flaps (53.1%) were bilateral. One hundred seventy-nine (85.6%) flaps were for primary reconstruction, and 30 (14.4%) flaps were for salvage of a previous breast reconstruction. Fourteen (6.7%) flaps were 1-stage LDF alone, 189 (90.4%) were 1-stage LDF with implant, 1 (0.5%) was 2-stage LDF with implant, and 5 (2.4%) were 2-stage LDF with tissue expander then implant. The mean follow-up was 44.9 months (range, 1-164 months). The most common complication was capsular contracture (29%). Overall complication rates were similar between primary and salvage reconstruction (35.8% vs 43.3%, P = 0.426), as was needed for revision (39.1% vs 40.0%, P = 0.926). There was a significant difference in complication rate (P = 0.021) but not revision rate (P = 0.133) between staging groups: 1-stage LDF alone, 7.1%, 14.3%; 1-stage LDF with implant, 40.2%, 41.8%; 2-stage LDF with implant, 0.0%, 0.0%; and 2-stage LDF with expander then implant, 0.0%, 20.0%. After removing capsular contracture, there was no difference in complication rates. Single-staged LDF/implant reconstruction remains a safe and reliable surgical option for both primary and salvage breast reconstruction. High rates of capsular contracture should prompt the deployment of techniques to reduce its incidence.