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Musculocutaneous LD Flap with Prosthesis Expander replacement by definitive implant 2 years ago.
(with Contralateral Augmented Due to local wound dehiscence and infection, the defini-
Mammaplasty) tive implant was removed last year.
Current diagnosis:
Patient: 41-year-old woman. Post infected implant removal.
Previous diagnosis: Current procedure:
Recurrent invasive ductal carcinoma at the right breast. Reconstructive procedure:
Previous procedure: Delayed right breast reconstruction with latissimus dorsi
Oncologic procedure: musculocutaneous flap with implant.
Right total mastectomy with sentinel lymph node biopsy Anatomical implant MX 470 g was selected.
2 years ago. Left breast augmented mammaplasty (with periareolar
She also had quadrantectomy and adjuvant radiotherapy 6 incision).
years ago. Round moderate profile 125 g was selected.
Reconstructive procedure:
Right breast immediate tissue expander reconstruction 2
years ago.
Fig. 21.3 The illustration outlines the back donor site of LD flap
Figs. 21.4, 21.5, and 21.6 Patient was placed in lateral position
It is necessary to take care about the right arm, shoulders, neck, hips, and knees to avoid pressure injuries
Musculocutaneous LD Flap with Prosthesis (with Contralateral Augmented Mammaplasty) 189
Figs. 21.7 and 21.8 The right mastectomy scar incision and cutaneous flap dissection
Figs. 21.9, 21.10, and 21.11 From the lateral part of the mastectomy site, the thoracodorsal vessels were dissected and identified
190 Case 21 Latissimus Dorsi Flap Technique
Fig. 21.12 The anterior border of the LD muscle was identified, and
the tunnel was created along the axillary region
Figs. 21.13, 21.14, 21.15, and 21.16 The LD flap incision was made then the subcutaneous tissue around the skin island was included in order
to have more volume and better cosmetic results
Musculocutaneous LD Flap with Prosthesis (with Contralateral Augmented Mammaplasty) 191
Fig. 21.17 The anterior border of LD flap was found, and this is the
anterior limit of this flap dissection
Figs. 21.18, 21.19, and 21.20 Then the LD flap was detached from its inferior insertion
Figs. 21.21 and 21.22 Medial border of the LD was dissected from the paraspinous fascia
It is important to identify and isolate the trapezius muscle from the medial and superior border
192 Case 21 Latissimus Dorsi Flap Technique
Figs. 21.23, 21.24, 21.25, 21.26, 21.27, 21.28, and 21.29 LD flap superomedial dissection
Identify the tip of the scapula and teres major muscle. Then the LD flap was dissected free from them
Figs. 21.30, 21.31, and 21.32 The LD flap was transposed to the anterior chest wall
The donor site closure
Musculocutaneous LD Flap with Prosthesis (with Contralateral Augmented Mammaplasty) 193
Figs. 21.33 and 21.34 Temporary closure of anterior thoracic wall that allows changing position of the patient from the lateral decubitus to
supine position
Figs. 21.36 and 21.37 The left breast superior periareolar incision and deepithelization
Figs. 21.38 and 21.39 Glandular tissue was dissected straight toward the pectoralis muscle
Figs. 21.40, 21.41, and 21.42 Subfascial plane was created for prosthesis implantation
Musculocutaneous LD Flap with Prosthesis (with Contralateral Augmented Mammaplasty) 195
Figs. 21.45 and 21.46 Round prosthesis placement on the left breast
Fig. 21.49 LD flap was spread over the right thoracic wall
Figs. 21.50 and 21.51 Complete undermining of the mastectomy skin envelope to create space for prosthesis and LD flap
Musculocutaneous LD Flap with Prosthesis (with Contralateral Augmented Mammaplasty) 197
Figs. 21.52 and 21.53 LD muscle was sutured at the superior inner part of the breast
Figs. 21.54 and 21.55 LD flap was set free at the lower lateral part to allow the placement of the prosthesis
198 Case 21 Latissimus Dorsi Flap Technique
Figs. 21.56, 21.57, 21.58, and 21.59 After prosthesis placement, the LD flap was transferred to cover the prosthesis
Musculocutaneous LD Flap with Prosthesis (with Contralateral Augmented Mammaplasty) 199