Latissimus dorsi mini-flap: a technique for extending breast conservation

Area of Science:

• Oncology
• Plastic Surgery
• Breast Surgery

Background:

• The latissimus dorsi (LD) flap has a long history in breast reconstruction.
• Current applications include filling defects after quadrantectomy or wide excision.
• Mastectomy is often required for large breast cancers, impacting cosmetic outcomes.

Purpose of the Study:

• To evaluate a two-stage procedure for large breast cancer excision using a latissimus dorsi (LD) mini-flap.
• To compare the oncological safety and cosmetic results of the LD mini-flap technique with standard wide local excision and mastectomy with immediate reconstruction.

Main Methods:

• A two-stage procedure involving wide local excision followed by axillary dissection and LD mini-flap transfer was performed on 25 patients.
• Cosmetic outcomes were compared to age-matched controls undergoing standard wide local excision or mastectomy with immediate reconstruction.

Main Results:

• The LD mini-flap group excised significantly more tissue than the standard wide excision group (p<0.001).
• Patients receiving LD mini-flaps reported better breast shape, resemblance to the contralateral breast, and less psychological distress compared to mastectomy patients (p=0.04, p=0.03).
• Patient-rated outcomes for the LD mini-flap were similar to standard wide local excision and superior to immediate whole breast reconstruction.

Conclusions:

• The two-stage wide local excision and LD mini-flap is an oncologically safe breast-conserving technique for larger tumors.
• This method offers improved cosmetic results compared to mastectomy with immediate breast reconstruction.
• It expands breast conservation options for patients with large localized operable breast cancer.