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

Results

Forty-one patients with 56 LD-reconstructed breasts were included. Patient demographics and surgical details are outlined in Table 2. Follow up ranged from 1 to 10 years (mean of 1 year). Table 3 details the Spectrum device selection, expansion procedure, and final implant volume. The most commonly used Spectrum device was the 325–390 cm3 implant (37.5%), and the average number of expansions per implant was 3.73 ± 0.43 (range 2–11 expansions). The final implant volume was 366.1 ± 32.7 cm3, with a range of 120–530 cm3.

The fate of expansion port removal is outlined in Table 4. The majority of patients (58.5%) kept the Spectrum device in place and had the expansion port removed under local anesthetic. The remaining expansion ports were either removed en bloc with the Spectrum device for any reason (24.4%) or were not removed at the time of this study (17.1%), as they were still in the post-expansion phase. The average duration the expansion port remained in situ for those who had them removed under local anesthetic was 9.29 ± 1.66 months.

Surgical outcomes for patients are outlined in Table 5. Overall, 6 patients (14.6%) had a major complication requiring a return to the main operating room. The most common reason for return to the main operating room was capsular contracture occurring in 4 patients and representing 66.7% of all major complications. Three patients required a partial capsulectomy (5.3%) and 1 required a capsulotomy with implant repositioning (1.8%). The remaining reasons for return to the main operating room were infection (1.8) and venous congestion of the LD flap (1.8%). Interestingly, on exploration this was found to be due to a kink in the thoracodorsal pedicle caused by tethering of the serratus branch. Five patients (12.2%) elected to have the Spectrum device exchanged for a gel implant due to position and/or appearance. In all 5 cases, patients desired more upper pole fullness to their reconstruction and thus a gel, high-profile implant was used to achieve this preference.

Eleven minor complications occurred, the most common of which was seroma formation at the breast site (3 patients). All of the breast seromas were in immediate reconstructions. Seromas were managed with the in situ suction drains placed at the time of the operation (one deep to and another superficial to the latissimus muscle) or, if the drains had already been removed, were aspirated in clinic. Seroma formation and delayed wound healing at the donor site were equally common, occurring in 2 patients each. Additional minor complications included delayed wound healing at breast site (1 patient), mastectomy flap necrosis (1 patient; managed with bedside debridement and secondary intention healing), minor infection at breast site (1 patient, managed with oral antibiotics), and minor infection at back donor site (1 patient, managed with oral antibiotics). No incidences of fat necrosis occurred. Fortunately, none of the complications affected adjuvant therapy and only 1 Spectrum device was compromised (due to infection).

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