Latissimus dorsi breast reconstruction utilizing functional muscle transfer and tissue expansion

Latissimus dorsi breast reconstruction with implants has been criticized for Baker III or IV capsular contractures in as many as 30% of patients. Also criticized is muscle atrophy and loss of breast volume and definition. This study evaluated 2 modifications of the classic latissimus reconstruction: muscle transferred as an innervated functional unit and tissue expansion posterior to the latissimus but anterior to the pectoralis muscle. After expansion, a permanent prosthesis was placed (46 silicone gel and 3 saline). Forty-nine such reconstructions were done in 32 patients (17 bilateral and 15 unilateral), with average follow-up of 19 months. Only 4 Baker III capsular contractures (8%) and no Baker IV contractures occurred. All patients demonstrated excellent retention of breast shape/definition. This study demonstrates that functional muscle transfer and tissue expansion results in low capsular contracture rates and excellent retained breast shape.