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Breast Reconstruction with Bilateral Latissimus Flaps:A Single Surgeon, Seven Year Consecutive Experience
Boris E. Goldman, MD1, Callie Kunze, PA2.
1Aesthetic Plastic Surgery Center, WESTPORT, CT, USA, 2Norwalk Hospital, Norwalk, CT, USA.

Background: With the advent of BRCA gene testing and proven benefits of prophylactic mastectomy in high risk patients, the number of bilateral mastectomies is increasing. While abdominal reconstruction has long been considered a mainstay of autogenous reconstruction, not all patients are candidates for, or desire a bilateral breast reconstruction with abdominal tissue. Although there is a great deal of literature on unilateral latissimus flap breast reconstruction, there are few papers on bilateral latissimus breast reconstruction.
Purpose: To evaluate a single surgeon's 7 year consecutive case experience with bilateral latissimus flap breast reconstruction; including patient satisfaction, and functional limitation surveys.
Methods: From 1/1/07-12/31/14, 16 consecutive patients (32 flaps) underwent bilateral latissimus flap breast reconstruction by the senior author. 14/16 bilateral procedures were performed simultaneously, and 2/16 were performed in a staged fashion early in the series. Mean age=46 years; mean BMI=23. Breast size ranged from A-DD cup. Pre and post operative radiation patients included. All patients had first stage tissue expander placement and preservation of the latissimus humeral insertion. On completion of treatment (1 year to 5 years follow up), all patients were provided with a questionnaire assessing their overall satisfaction, aesthetic satisfaction, limitation to exercise, limitation to shoulder ROM, change in strength, and limitation to performing ADL's. Micro fat grafting was utilized as an adjunct procedure for patients later in the series. Nipple/areolar reconstructions were performed with skate flaps/ tattoo.
Results: There were no flap losses, no hematomas, and no seromas. 1/32 breasts developed capsular contracture (Baker IV), that required capsulectomy. 2/32 breasts (1 patient) with a history of prior radiation had partial mastectomy skin flap necrosis; but went on to successful completion of reconstruction. Survey results (15/16 responded): General satisfaction 5/5 (5=very satisfied); Aesthetic satisfaction 4.9/5 (5=very satisfied), Limitation to work 4.8/5 (5=No limitation), ROM arm/shoulder 4.7/5 (5=No limitation), Change in strength 4.6/5 (5=No change), Limitation to exercise 4.6/5 (5=No limitation), Limitation to ADL's 4.8/5 (5=No limitation).
Conclusion: Bilateral latissimus flap breast reconstruction is an excellent option in those patients that do not desire or are not candidates for bilateral abdominal reconstruction (DIEP/TRAM). Aesthetic satisfaction and general satisfaction was excellent in the patients studied with minimal post-operative surgical or functional morbidity. Figures 1 and 2 are post-operative examples.
Fig. 2

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