Background: Various breast reconstruction techniques
after mastectomy have been developed over the last few years
based on the idea of volume replacement, either by autologous
flaps, such as Latissimus dorsi (LD) flap or device-based
techniques, such as implants. Combined Endoscopic LD flap < br />with fat graft is an advanced technique that enhances the
muscle volume and lower the postoperative complications.
Objectives: Comparison between combined Endoscopic
LD Flap with fat graft versus extended LD Flap for breast
reconstruction in breast cancer patients regarding the aesthetic
outcome, and patient satisfaction on long term results.
Patients and Methods: There were 40 female patients
with early invasive breast carcinoma, including stages I, II,
and III A, in accordance with the American Joint Committee
on Cancer (AJCC) staging system (1) in this comparative
analysis. Twenty patients each performed skin sparing mastectomy
and immediate reconstruction using the conventional
extended (LD) flap technique and the endoscopic (LD) flap < br />with fat graft technique. Volume differences between the two
studied groups that were evaluated before the surgery and six
months after surgery were noted. Additionally, the donor site
scar and patient satisfaction with the reconstructed breast
were compared.
Results: When compared to the conventional group, there
was a substantial average volume decrease of the reconstructed
breast in the endoscopic group (38.1 versus 18.1 percent,
p=0.001). Despite the fact, the endoscopic group's operation
took longer time than the conventional group's (203 vs 151
min, p=0.017), which is considered a disadvantage, donor
site scar and postoperative seroma was better in the endoscopic
group.
Conclusion: Endoscopic LD muscle flap with fat graft is
better than Extended Latissimus dorsi muscle flap for breast
reconstruction regarding overall patient satisfaction and post
operative donor site complications. Therefore, endoscopic
LD muscle flap with fat graft could represent an alternative
technique to Extended LD muscle flap in cases of early
invasive breast cancers, including stages I, II, and IIIA, as
specified by American Joint Committee on Cancer (AJCC)
staging system (1)