The long-term impact of oncoplastic breast conserving surgery using Latissimus Dorsi miniflaps on mammographic surveillance and the detection of local recurrence

Publication date: Available online 28 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): S. Mele, D. Wright, N. Paramanathan, S. Laws, L. Peiris, R. Rainsbury
IntroductionLatissimus Dorsi Miniflap is a breast-conserving volume replacement technique for reconstruction of large breast defects. While mammographic features of Mini Flap reconstruction have been described, little is known about the incidence, mode of presentation and size of local recurrence after this procedure. The aim of this study was to investigate the impact of Latissimus Dorsi Miniflap reconstruction on frequency, presentation and detection of local recurrence.MethodsClinical, radiological and pathological data were reviewed in 216 patients. Complete records were available for 11 patients developing local recurrence, including mode, time of presentation and size of the recurrent tumours. All mammograms before and after local recurrence were assessed in relation to a range of specific characteristics including parenchymal density, flap visibility, architectural distorsion, mass, calcifications, fat necrosis, skin thickening and breast oedema.ResultsLocal recurrence was developed by 21 patients at 10.4yr following reconstruction (mean age 49yr, resection weight 182gm, tumour size 33mm). Following radiotherapy, 0.5% of patients developed local recurrence each year, increasing 5-fold when radiotherapy was omitted (HR 4.99). Local recurrences were diagnosed in 5 patients by mammography alone, in 3 by mammography and palpable lump, and in 3 by palpable lump alone. They were detected when small (15mm), and were associated with new mammographic abnormalities in ten patients.ConclusionsLong follow up demonstrates that Latissimus Dorsi Miniflap reconstruction allows oncologically safe breast conservation when combined with postoperative radiotherapy. Local recurrences are detected early, either by mammography, clinical examination or both, and detection is not compromised by the presence of a flap.



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