Dermolipectomy of the lateral thoracic fat compartment in secondary breast reconstruction revision: Anatomical and clinical results

Fullness in the lateral thoracic area following breast reconstruction can be a source of concern for patients. This redundant tissue creates disharmony between the newly reconstructed breast, the lateral mammary fold, and the lateral thoracic compartment. In this article we present the results of our anatomical/histological study, discuss the operative technique and present a clinical series of patients who underwent this procedure. Methods: Cadaveric Anatomical study: Dye injection studies on 4 hemi-chests to determine if the lateral thoracic fold is a separate anatomic fat compartment. Tissue from the boundaries between identified compartments was also submitted for routine H&E histological analysis. Clinical study: Retrospective case note analysis of all patients undergoing dermolipectomy performed by the senior author. Results: In the analyzed cadavers, a clear line of delineation was found separating the lateral thoracic fold from the breast and adjacent structures, this was confirmed histologically. Forty patients underwent 64 dermolipectomy procedures. The average dimension of the resected specimen was 13.37 cm (range 3.0-25.0 cm) x 5.44 cm (range 1.0-12.0 cm). The mean time of dermolipectomy following initial reconstruction was 15.4 months. As the BMI increased the average resection size increased both in length (p = 0.002) and width (p = 0.006). There were no postoperative complications. Conclusion: The lateral thoracic fold is a distinct fat compartment. Dermolipectomy following breast reconstruction is a useful adjunct and should be considered in any patient with excess skin/subcutaneous tissue in the lateral thoracic region. The procedure has a low complication rate and can be performed in conjunction with other post reconstruction refinement procedures. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.