‘Scarless’ flap provides new alternative for breast reconstruction

Saturday, May 17, 2014

Washington: An innovative “scarless” flap technique provides a new option for breast reconstruction, with a shorter operative time and lower complication rate compared to a traditional flap design, suggests a report in Plastic and Reconstructive Surgery — Global Open (PRS GO), journal of the American Society of Plastic Surgeons (ASPS).

Developed by Australian plastic surgeons, the scarless latissimus dorsi flap is a “safe” and versatile alternative for breast reconstruction after mastectomy. It may be particularly appropriate for women undergoing prophylactic mastectomy to reduce breast cancer risk, according to the paper by Dr Mark A Lee of St John of God Hospital, Subiaco, and Dr Kirstin G Miteff of Royal Perth Hospital, Perth, Western Australia.

From 2009 to 2012, Dr Lee used the scarless latissimus dorsi flap for 30 breast reconstructions in 20 women. It’s not a new idea to use flaps based on the latissimus dorsi muscle — the largest muscle of the back — for breast reconstruction.

What’s new is the approach to accessing the latissimus dorsi without the need for an additional incision on the back — or two incisions, if both breasts are being reconstructed. Although it’s not literally “scarless,” the new flap design avoids scars, pain, and possible complications related to the additional incisions.

In Dr Lee’s experience, operative time was about one hour shorter using scarless reconstruction, compared to 20 women undergoing reconstruction with traditional latissimus dorsi flaps. This contributed to a reduced complication rate: about one-fourth lower than in the traditional group. Women undergoing scarless reconstruction also went home from the hospital about a day and a half earlier.

About three-fourths of women in both groups rated their aesthetic results good to excellent. They also had similar overall scores on the BREAST-Q questionnaire, which assesses various aspects of quality of life after breast reconstruction. However, BREAST-Q subscale scores for breast appearance suggested better aesthetic results with the scarless flap.

Modern surgical techniques provide good “oncologic control” of breast cancer while preserving much of the woman’s own breast tissue for use in immediate reconstruction. A biomaterial called acellular dermal matrix (ADM) is a popular new option for immediate reconstructions. While ADM has some advantages—especially in avoiding the need for skin flaps—it is expensive and carries a risk of potentially serious complications. In addition, because of its high cost and need for special training and equipment, ADM isn’t available everywhere.

Dr Lee and Dr Miteff believe the scarless latissimus dorsi flap provides a useful alternative to the use of ADM, including settings where ADM isn’t available or practical for use. The open access format of PRS GO allows the authors to present and illustrate their technique in detail to a global audience.

Immediate reconstruction is also performed in women at high genetic risk undergoing mastectomy to prevent breast cancer. The researchers believe that the scarless technique may offer “great advantage” for this rapidly growing group of young patients.

In another significant benefit, the scarless technique eliminates the need to turn the patient during anaesthesia, which is necessary to obtain the traditional latissimus dorsi flap. This contributes to the shorter operative time, helping to use the plastic surgeon’s time more efficiently.

“This method of breast reconstruction is relatively time effective, requires no patient repositioning, and uses standard breast instruments,” Dr Lee and Dr Miteff conclude. Further evaluation—including comparison with reconstructions using ADM—will be needed to determine the role of the scarless latissimus dorsi flap in modern approaches to breast reconstruction.

Categories: Plastic Surgery, RESEARCH

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