Subfascial Harvest of the Extended Latissimus Dorsi Myocutaneous Flap in Breast Reconstruction: A Comparative Analysis of Two Techniques

Widespread adoption of the extended latissimus dorsi myocutaneous flap in breast reconstruction has been limited by donor-site complications. The dissection plane may be either above or below the superficial layer of the thoracolumbar fascia, which may be transferred with the flap or retained on the back skin flaps. The aim of this study was to investigate whether varying the plane of dissection improves donor-site morbidity and complications. A comparative analysis of consecutive women treated with extended latissimus dorsi myocutaneous breast reconstruction by a single surgeon (D.F.) between 2006 and 2012 was performed. Eighty patients were reviewed. Between 2006 and 2011, 47 patients were treated with traditional suprafascial harvest (group A); the subsequent 33 patients between 2011 and 2012 had subfascial harvest (group B), retaining the superficial fascia on the back skin flaps. When compared with group A, group B patients showed significant reduction in both mean number of seroma drainage events (p = 0.027) and mean total aspirated seroma volume, which was reduced by half (p = 0.006). Group B patients also reported significant reduction in donor-site pain (p = 0.041) and donor-site scar adherence to the chest wall (p = 0.026). No increases in flap or donor-site dehiscence, partial flap loss, or other minor or major complications were observed. The technique of subfascial harvest during autologous latissimus dorsi flap breast reconstruction significantly improves back donor-site morbidity without compromising flap survival. Therapeutic, III.