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Obesity and the Latissimus Dorsi Flap: A Radiologic Study.

Joshua H Choo1, Bradley J Vivace2, Luke T Meredith2

  • 1Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA.

Plastic Surgery (Oakville, Ont.)
|May 15, 2023
PubMed
Summary

Obesity increases latissimus dorsi flap (LDF) thickness and subfascial fat in breast reconstruction patients. This finding supports extended LDF harvests for greater autologous volume in obese individuals.

Keywords:
breastbreast autologous reconstructionextended latissimus dorsi flapreconstruction in obese patients

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Area of Science:

  • Plastic Surgery
  • Breast Reconstruction
  • Obesity Medicine

Background:

  • Rising obesity rates in breast cancer patients necessitate re-evaluation of latissimus dorsi flap (LDF) utility.
  • Challenges exist in achieving adequate volume with purely autologous LDF reconstruction in obese patients.
  • Combined LDF and prosthetic approaches face increased complications due to flap thickness in obese individuals.

Purpose of the Study:

  • To quantify latissimus dorsi flap component thicknesses in relation to body mass index (BMI).
  • To assess the implications of these measurements for breast reconstruction in patients with varying BMI.
  • To provide data supporting extended latissimus dorsi flap harvests for enhanced autologous volume.

Main Methods:

  • Computed tomography (CT) scans of 518 patients were analyzed for soft tissue and subfascial fat layer thicknesses.
  • Measurements were taken at the standard latissimus dorsi flap donor site.
  • Patient demographics, including age, gender, and BMI, were correlated with flap measurements.

Main Results:

  • Latissimus dorsi flap thickness and subfascial fat layer thickness significantly increased with higher BMI.
  • Each 1-point BMI increase correlated with a 1.11 mm increase in total flap thickness and a 0.513 mm increase in subfascial fat thickness.
  • The subfascial fat layer's contribution to total flap thickness increased with BMI, reaching 35% in class III obese individuals.

Conclusions:

  • Latissimus dorsi flap and subfascial fat thickness are strongly correlated with patient BMI.
  • The increasing proportion of subfascial fat with higher BMI favors extended latissimus dorsi flap harvests for greater volume.
  • These findings aid in estimating achievable autologous volume from extended latissimus dorsi flap techniques in obese patients.