Association of Unilateral Latissimus Dorsi Muscle Harvest for Breast Reconstruction with Postoperative Spinal Posture

The latissimus dorsi muscle originates from the lower thoracic spine with broad attachment and plays a subsidiary role in spinal postural stability. The authors investigated whether harvesting unilateral latissimus dorsi muscle for breast reconstruction could influence spinal posture in the long term.

Patients who underwent immediate unilateral breast reconstruction between 2002 and 2010 were reviewed. They were grouped according to reconstruction methods: latissimus dorsi muscle flap and tissue expander/implant. The Cobb angle was assessed twice at each of five different time points (preoperatively and 2, 4, 6, and 8 years postoperatively) by an independent physician blinded to the reconstruction modality. Postoperative scoliosis was defined as a mean Cobb angle greater than 10 degrees at 8 years postoperatively. The trends of changes in Cobb angle over time and the rates of postoperative scoliosis were compared between reconstruction methods.

In total, 153 women were analyzed, including 102 using latissimus dorsi muscle flap and 51 using tissue expander/implant, with a median follow-up of 103 months. The latissimus dorsi flap group showed enhanced trends of increasing postoperative Cobb angles as compared with the tissue expander/implant group, and the difference remained significant after adjusting for other variables ( p = 0.001). The rate of postoperative scoliosis was significantly higher in the latissimus dorsi flap group than in the control group ( p = 0.029). Multivariable analyses revealed that use of the latissimus dorsi flap was associated with a significantly increased rate of postoperative scoliosis.

Unilateral latissimus dorsi muscle flap harvest for breast reconstruction might be associated with changes in spinal posture in the long term.