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Muscular Versus Myo-cutaneous Latissimus Dorsi Flap in Delayed Breast Reconstruction: A Comparative Study of
Annalisa Cogliandro1, Riccardo De Bernardis2, Giovanni Calabrese1
1Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
Introduction:
The latissimus dorsi (LD) flap, either muscular or myo-cutaneous, is an effective autologous option for breast reconstruction in cases of poor local tissue quality. The technique is reliable, with low complication rates and good patient acceptance. The surgical incision site impacts postoperative outcomes in terms of aesthetics, psychosocial well-being, physical comfort, scar perception, and sensory changes, assessable through Patient-Reported Outcome Measures (PROMs).
Materials And Methods:
We conducted a cross sectional study on patients who underwent delayed monolateral LD flap breast reconstruction after mastectomy between 2018 and 2022.
Inclusion Criteria:
(1) delayed LD flap reconstruction; (2) ≥ 2 years of follow-up; (3) standardized pre- and postoperative photo documentation; (4) proficiency in Italian language; (5) signed informed consent. All procedures were performed by the same surgical team. Patients completed BREAST-Q and SCAR-Q modules at least one year postoperatively.
Results:
Thirty-one patients were included: 16 with myo-cutaneous LD flaps (Group 1) and 15 with Z-scar muscular LD flaps (Group 2). Group 2 reported significantly better SCAR-Q scores in "Appearance" (p = 0.001), "Symptoms" (p = 0.021), and "Psychosocial Impact" (p = 0.019). In the BREAST-Q LD module, "Satisfaction with back" was higher in Group 2 (p = 0.016), while "Physical well-being: back and shoulder" was similar (p = 0.998).
Conclusions:
Both techniques achieved high patient satisfaction, but the muscular LD flap showed significantly better donor site scar satisfaction. Larger studies with longer follow-up and bigger sample size are needed to confirm these findings and optimize surgical decision-making.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
