Muscle-Sparing Latissimus Dorsi Flap in Breast Reconstruction: Experience from a Tertiary Care Center in a Developing Country

Larger breast tumors that are unsuitable for breast conservation surgeries are common in the developing world and are usually treated with mastectomy. This report showcases our experience with the muscle-sparing latissimus dorsi (MSLD) flap for breast reconstruction after wide local excision or partial mastectomy. This is a retrospective review of patients undergoing breast reconstruction with MSLD flap after wide local excision between February 2016 and June 2018. The study of the aesthetic and functional outcomes was the primary objective and postoperative morbidity (pain, seroma, flap necrosis) as secondary objective. The aesthetic outcome was assessed individually by the patient and doctor as satisfactory, fair, good, and excellent. Donor site appearance was graded as satisfactory or unsatisfactory. Disability of the shoulder was assessed subjectively (limitation to perform activities involving overhead abduction at shoulder joint) and objectively by measuring the range of motion at shoulder joint. Ten patients (5 carcinoma, 5 phyllodes) were included. The mean tumor size at time of operation was 4.2 cm for breast cancer patients (assessable in 4 patients) and 6.5 cm (4-9.5 cm) for phyllodes. Skin island of flap had a mean size of 7.5 x 8 cm. Donor site was closed primarily. No donor site seroma was seen. Necrosis of flap margins occurred in one. The aesthetic outcome was good in two and excellent in eight; donor site was rated as satisfactory in all. No patient experienced disability of the shoulder on subjective assessment and objective assessment. MSLD flap offers a satisfactory aesthetic outcome with minimal functional arm compromise or donor site morbidity.