Latissimus Dorsi Flap for Secondary Breast Reconstruction after Partial TRAM Flap Loss.

Song, Jae Min; Yang, Jung Dug; Lee, Sang Yun; Jung, Ki Ho; Chung, Ho Yun; Cho, Byung Chae

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Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(1):75-79.
Published online January 1, 2009.

Latissimus Dorsi Flap for Secondary Breast Reconstruction after Partial TRAM Flap Loss.

Jae Min Song, Jung Dug Yang, Sang Yun Lee, Ki Ho Jung, Ho Yun Chung, Byung Chae Cho

Department of Plastic and Reconstructive Surgery, College of Medicine, Kyungpook National University, Daegu, Korea. lambyang@paran.com

Abstract

PURPOSE
The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. METHODS: Case1: A 50-year-old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51-year-old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done.
RESULTS
Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients.
CONCLUSION
LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstruction.

Keywords: TRAM flap; Partial flap necrosis; Fat necrosis; LD flap

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