Single-Stage Latissimus Dorsi Breast Reconstruction Using Spectrum Devices

Outcomes and Technique

Colton Boudreau, MSc; Kaitlin S. Boehm, MD, Med; Aevan MacDonald; Jason Williams, MEd, MD, FRCSC

Disclosures

Plast Reconstr Surg Glob Open. 2021;9(5):e3282 

In This Article

Abstract and Introduction

Abstract

Background: Latissimus dorsi (LD) flap is a workhorse flap in breast reconstruction. Despite many advantages, the primary criticism of this flap is the requirement of a second surgery to exchange expansion devices for permanent implants. This study reports a single-stage reconstruction and outcomes wherein Spectrum devices (Mentor, Irving, TX), which serve as expanders and permanent implants, are used, and expansion ports are removed under local anesthetic.

Methods: A retrospective chart review of all patients undergoing LD flap reconstruction with Spectrum device by a single surgeon at a single center during a 10-year period was performed. All patients, unilateral/bilateral, immediate/delayed were included. Details of implants, surgical procedure(s), and follow-up visits were assessed for patient outcomes.

Results: In total, 41 patients and 56 breasts were included. Of the total patients, 58.5% retained the Spectrum device and had the expansion port removed under local anesthetic. An estimated 6 major complications occurred (14.6%), requiring return to the operating room: 3 patients required a capsulectomy, 1 a capsulotomy/implant repositioning, one had loss of implant (infection), and 1 had venous congestion of the flap. Eleven minor complications occurred (26.8%): 5 seromas (3 at the breast site, 2 at the donor site), 3 delayed wound healings (2 at donor site, 1 at breast site), 1 mastectomy flap necrosis, 2 infections (1 at each breast site, 1 at donor site).

Conclusions: This study provides details of a single-stage LD flap with Spectrum device breast reconstruction that can be considered when performing an LD reconstruction. This technique is efficient and safe with comparable complication profile.

Introduction

Despite the advances and increasing prevalence of autologous, abdominally-based breast reconstruction, the latissimus dorsi (LD) flap remains an important option for certain cases in primary and salvage reconstructions as well as for high-risk patients (morbid obesity, preoperative radiation, and clotting disorders).[1–3] The LD muscle or myocutaneous flap remains a pillar in breast reconstructive algorithms due to its high reliability, shorter operating times, and hospital stays compared with free tissue transfer, minimal donor site morbidity, and high patient satisfaction.[1,2,4–6] Recent innovations to the LD flap include direct to implant (DTI) reconstructions with acellular dermal matrix.[3,7]

From both resource-conscious healthcare systems and patient experience perspectives, LD reconstructions can offer advantages over other techniques, with the exception of requiring a second stage to exchange a tissue expander for a permanent implant.[2,5,7–9] Devices that act as both tissue expander and permanent implant are available, such as Mentor's Spectrum devices (Irving, Tex.). Despite the rise in DTI, LD flap with acellular dermal matrix reconstructions achieving symmetry and avoiding mastectomy flap ischemia can be a challenge. The use of the saline Spectrum adjustable expander/implant (Mentor, Irving, Tex.) offers the opportunity to perform a single-stage LD reconstruction with implants, while still offering the opportunity for the implant to be adjusted for size and symmetry postoperatively. Removing the expansion port under local anesthetic avoids the need for a second return to the main operating room.[10] Additionally, compared with expanders with an integrated port, Spectrum implants allow expansion to be performed remotely from the breast pocket, potentially reducing the risk of infection or rupture. Remote ports are also technically easier to use, particularly in patients with thick LD flaps. In these patients, it can be difficult to find the integrated port using a magnet, which can, at times, require a spinal needle to penetrate the integrated port.[11]

The aim of this study was to report the technique and experience with single-stage LD breast reconstruction using Spectrum implants (Mentor, Irving, Tex.).

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