Efficacy and Safety of Immediate Latissimus Dorsi Breast Reconstruction after Breast Cancer Surgery


Breast cancer, Breast reconstruction, Latissimus dorsi flap, Prosthesis implantation


How to Cite

Xia, X., Chen, Z., Cao, L., Zhou, J., & Chen, Z. (2023). Efficacy and Safety of Immediate Latissimus Dorsi Breast Reconstruction after Breast Cancer Surgery. Iranian Red Crescent Medical Journal, 25(8). https://doi.org/10.32592/ircmj.2023.25.8.2817


Background: Most traditional breast reconstruction surgeries require the removal of the patient's own tissue or the use of artificial implants for reconstruction. The improvement of the efficiency and safety of breast reconstruction surgery assumes critical importance for the rehabilitation of breast cancer patients. Immediate latissimus dorsi breast reconstruction surgery, which utilizes the patient's own tissue to perform immediate reconstruction, can address this issue in a targeted manner, avoiding the cumbersome and complex nature of multiple surgeries.

Objectives: To analyze the efficacy and safety of immediate latissimus dorsi breast reconstruction (BR) after breast cancer surgery.

Methods: A total of 91 female patients with breast cancer diagnosed and treated by breast surgery in our hospital from August 2017 to July 2021 were retrospectively analyzed. The patients were assigned to the prosthetic implant group (n=39) and latissimus dorsi group (n=52) according to the method of immediate postoperative BR. The difference in curative effect can be analyzed by comparing the operation time, intraoperative bleeding, postoperative drainage time, and aesthetic evaluation of BR. The safety of postoperative BR was analyzed by comparing the postoperative complications, local recurrence rate, distant metastasis rate of breast cancer, and rehabilitation rate.

Results: There was no dramatic difference in intraoperative bleeding, postoperative drainage time, and rehabilitation rate between the latissimus dorsi and prosthetic implantation groups (P>0.05). Nonetheless, there was a significant difference in operation time, aesthetic evaluation of BR, postoperative complications, local recurrence rate, and distant metastasis rate of breast cancer in the latissimus dorsi group than the prosthetic implant group(P<0.05). In general, the latissimus dorsi group exhibited better therapeutic effects.

Conclusion: Immediate latissimus dorsi BR dramatically affects postoperative breast repair of breast cancer patients and is safer than prosthesis implantation. As an evaluation of their safety and effectiveness, it is necessary to provide patients with more stable and reliable medical outcomes to ensure their surgical safety.



Yabe S, Nakagawa T, Oda G, Ishiba T, Aruga T, Fujioka T, et al. Association between skin flap necrosis and sarcopenia in patients who underwent total mastectomy. Asian J Surg. 2021;44(2):465-70. doi: 10.1016/j.asjsur.2020.11.001.

Song H, Sasada S, Masumoto N, Kadoya T, Shiroma N, Orita M, et al. Detectability of breast tumors in excised breast tissues of total mastectomy by IR-UWB-radar-based breast cancer detector. IEEE Trans Bio-Med Eng. 2019;66(8):2296-305. doi: 10.1109/TBME.2018.2887083. [PubMed: 30571614].

Postlewait LM, Subhedar PD, Geng F, Liu Y, Gillespie T, Arciero CA. Patterns of completion axillary dissection for patients with clinical T1-2N0 breast cancer undergoing total mastectomy with positive sentinel lymph nodes. J Amer Coll Surgeons. 2021;233(5):S37. doi: 10.1016/j.jamcollsurg.2021.07.052.

Arsh A, Ullah I. Shoulder pain and disability among post mastectomy patients. Physik Med Rehabil Kurortmedi. 2019;29(03):151-5.

Song J, Han Y, Liu J, Cheng K, Gao Q, Wang X, et al. Using KISS flaps in a chest wall reconstruction after mastectomy for locally advanced breast cancer: A new technique. Surg Innovat. 2019;27(1):5-10. doi: 10.1177/1553350619877299.

Gisladottir LD, Birgisson H, Agnarsson BA, Jonsson T, Tryggvadottir L, Sverrisdottir A. Comparison of diagnosis and treatment of invasive breast cancer between Iceland and Sweden. Laeknabladid. 2020;106(9):397-402. doi: 10.17992/lbl.2020.09.595. [PubMed: 32902398].

Zehra S, Doyle F, Barry M, Walsh S, Kell MR. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer. 2020;27(4):534-66. doi: 10.1007/s12282-020-01076-1. [PubMed: 32162181].

Chang EI, Ibrahim A, Liu J, Robe C, Suami H, Hanasono MM, et al. Optimizing quality of life for patients with breast cancer–related lymphedema: a prospective study combining DIEP flap breast reconstruction and lymphedema surgery. Plast Reconstr Surg. 2020;145(4):676-85. doi: 10.1097/PRS.0000000000006634. [PubMed: 32221193].

Nealon KP, Weitzman RE, Sobti N, Gadd M, Specht M, Jimenez RB, et al. Prepectoral direct-to-implant breast reconstruction: safety outcome endpoints and delineation of risk factors. Plast Reconstr Surg. 2020;145(5):898-908. doi: 10.1097/PRS.0000000000006721. [PubMed: 32332523].

Xie JR, Qi WX, Cao L, Cai G, Xu C, Chen JY. Complications and pattern of failure following immediate breast reconstruction after breast cancer surgery: A retrospective analysis over nine years. Int J Radiat Oncol Biol Phys. 2020;108(3):16-7. doi: 10.1016/j.ijrobp.2020.07.1026.

Pittermann A, Radtke C. Psychological aspects of breast reconstruction after breast cancer. Breast Care. 2019;14(5):298-301. doi: 10.1159/000503024. [PubMed: 31798389].

Tedesco D, Loerzel V. Breast reconstruction: impact of patient-centered, expectations-based education on women undergoing reconstructive surgery after mastectomy. Clin J Oncol Nurs. 2020;24(2):186-94. doi: 10.1188/20.CJON.186-194. [PubMed: 32196016].

Mericli AF, McHugh T, Kruse B, DeSnyder SM, Rebello E, Offodile II AC. Time-driven activity-based costing to model cost utility of enhanced recovery after surgery pathways in microvascular breast reconstruction. J Amer Coll Surgeons. 2020;230(5):784-94. doi: 10.1016/j.jamcollsurg.2020.01.035. [PubMed: 32224032].

Holoyda KA, Simpson AM, Ye X, Agarwal JP, Kwok AC. Immediate bilateral breast reconstruction using abdominally based flaps: An analysis of the nationwide inpatient sample database. J Reconstr Microsurg. 2019;35(08):594-601. doi: 10.1055/s-0039-1688719. [PubMed: 31075801].

Kanesalingam K, Heilat G, Sood S, Samarasinghe P, Elder E, French J, et al. Postmastectomy radiotherapy and immediate implant‐based breast reconstruction: attitudes and practices of Australian and New Zealand breast surgeons. Anz J Surg. 2019;89(10):1186-7. doi: 10.1111/ans.15288. [PubMed: 31621162].

Kung TA, Kidwell KM, Speth KA, Pang JC, Jagsi R, Newman LA, et al. Radiation-Induced skin changes after postmastectomy radiation therapy: A pilot study on indicators for timing of delayed breast reconstruction. J Reconstr Microsurg. 2019;35(03):209-15. doi: 10.1055/s-0038-1670650. [PubMed: 30231269].

Flor Flores-Balcázar CH, Castro-Alonso FJ, Hernández-Barragán TP, Delgado-de la Mora J, Daidone A, Trejo-Durán GE. The role of postmastectomy radiotherapy in locally advanced breast cancer after pathological complete response to neoadjuvant chemotherapy. Oncology. 2021;35(3):139-43. doi: 10.46883/ONC.2021.3503.0139. [PubMed: 33818049].

Gravina PR, Pettit RW, Davis MJ, Winocour SJ, Selber JC. Evidence for the use of acellular dermal matrix in implant-based breast reconstruction. Semin Plastic Surg. 2019;33(04):229-35. doi: 10.1055/s-0039-1696986. [PubMed: 31632205].

Baldwin A, Uy L, Frank-Kamenetskii A, Strizzi L, Booth BW. The in vivo biocompatibility of novel tannic acid-collagen type I injectable bead scaffold material for breast reconstruction post-lumpectomy. J Biomater Appl. 2020;34(9):1315-29. doi: 10.1177/0885328219899238.

Flanagan MR, Zabor EC, Romanoff A, Fuzesi S, Stempel M, Mehrara BJ. A comparison of patient-reported outcomes after breast-conserving surgery and mastectomy with implant breast reconstruction. Ann Surg Oncol. 2019;26(10):3133-40. doi: 10.1245/s10434-019-07548-9. [PubMed: 31342397].

Persing S, Manahan M, Rosson G. Enhanced recovery after surgery pathways in breast reconstruction. Clin Plast Surg. 2020;47(2):221-43. doi: 10.1016/j.cps.2019.12.002. [PubMed: 32115049].

Nayyar A, Strassle PD, Reddy KG, Jameison DI, Moses CG, Roughton MC, et al. Variations in the utilization of immediate post-mastectomy breast reconstruction. Amer J Surg. 2019;218(4):712-5. doi: 10.1016/j.amjsurg.2019.07.025. [PubMed: 31542150].

Yfantis A, Sarafis P, Moisoglou I, Tolia M, Intas G, Tiniakou I, et al. How breast cancer treatments affect the quality of life of women with non- metastatic breast cancer one year after surgical treatment: A cross-sectional study in Greece. BMC Surg. 2020;20(1):210-21. doi: 10.1186/s12893-020-00871-z. [PubMed: 32957940].

Houvenaeghel G, Cohen M, Ribeiro SR, Barrou J, Heinemann M, Frayret C, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest: technique and results. Surg Innovat. 2020;27(5):481-91. doi: 10.1177/1553350620917916. [PubMed: 32418492].

Francis DM, Brower JV. Post-mastectomy radiation after immediate reconstruction for multifocal early-stage breast cancer; to irradiate or not? Int J Radiat Oncol Biol Phys. 2020;108(5):1129-30. doi: 10.1016/j.ijrobp.2019.11.413. [PubMed: 33220221].

Grubstein A, Rapson Y, Stemmer SM, Allweis T, Wolff-Bar M, Borshtein S, et al. Timing to imaging and surgery after neoadjuvant therapy for breast cancer. Clin Imag. 2021;71(6):24-8. doi: 10.1016/j.clinimag.2020.10.043. [PubMed: 33171362].

Riccardo P, Filippo M. Extent of breast surgery after neoadjuvant chemotherapy for triple-negative breast cancer. JAMA Surg. 2020;155(8):785-6. doi: 10.1001/jamasurg.2020.1021. [PubMed: 32401290].

Zhu L, Mohan AT, Vijayasekaran A, Hou C, Sur YJ, Morsy M, et al. Maximizing the volume of latissimus dorsi flap in autologous breast reconstruction with simultaneous multisite fat grafting. Aesthet Surg J. 2016;36(2):169-78. doi: 10.1093/asj/sjv173. [PubMed: 26546990].

Mak JC, Kwong A. Complications in post-mastectomy immediate breast reconstruction: a ten-year analysis of outcomes. Clin Breast Cancer. 2020;20(5):402-7. doi: 10.1016/j.clbc.2019.12.002. [PubMed: 32665188].

Kalvala J, Parks RM, Green AR, Cheung KL. Concordance between core needle biopsy and surgical excision specimens for Ki‐67 in breast cancer – a systematic review of the literature. Histopathology. 2022;80(3):468-84. doi: 10.1111/his.14555. [PubMed: 34473381].

Miller ME, Muhsen S, Zabor EC, Flynn J, Olcese C, Giri D, et al. Risk of contralateral breast cancer in women with ductal carcinoma in situ associated with synchronous ipsilateral lobular carcinoma in situ. Ann Surg Oncol. 2019;26(13):4317-25. doi: 10.1245/s10434-019-07796-9. [PubMed: 31552614].