Extending the role of breast-conserving surgery by immediate volume replacement

Cosmetic failure following breast-conserving surgery is commonly caused by volume loss, and the effect of immediate volume replacement on cosmetic outcome using a latissimus dorsi miniflap (LDMF) has been investigated. The technique avoids a frontal scar and allows a wide retromammary excision via a lateral approach.

Twenty patients who had LDMF reconstruction were compared with 38 who had wide local excision (WLE) without reconstruction between 1991 and 1994. Cosmetic outcome was judged using (1) breast retraction assessment and (2) panel assessment, recording the frequency of cosmetic failure.

Patients who had LDMF reconstruction were younger (mean 45.1 versus 58.6 years; P < 0.0001) with larger tumours (mean 2.5 versus 1.3 cm; P < 0.0001) and underwent wider specimen excision (57 versus 13 per cent more than 150 g; P = 0.004) with reduced margin involvement (10 versus 37 per cent positive margins; P = 0.03) compared with those who had WLE. Cosmetic failure was uncommon after immediate volume replacement (LDMF 10 per cent versus WLE 34 per cent; P = 0.045).

LDMF reconstruction extends the role of breast-conserving surgery without cosmetic penalties, and may reduce the need for mastectomy.