Li Wai-Yee
Aesthet Surg J. 2024 Dec 12;45(1):63-70. doi: 10.1093/asj/sjae184.
The latissimus dorsi pedicled (LAT) flap has been a workhorse flap for breast reconstruction for many decades. The asymmetric back scar has been a major source of complaint. In patients with excess back adiposity, we can utilize the skin paddle harvest to improve back contour. We combined the principles of the aesthetic bra-line back lift with the LAT flap to provide simultaneous improvement of both posterior upper trunk adiposity and skin excess, which together form "back rolls," with a concealed scar.
The objective was to establish a new surgical technique of combined bra-line back lift with latissimus dorsi flap (BLBL-LAT flap) for aesthetic breast reconstruction.
This was an IRB-approved retrospective single-surgeon study performed in a national cancer center. We included patients undergoing breast reconstruction with the combined BLBL-LAT flap between 2015 and 2023, with a minimum of 6 months of follow-up.
A total of 106 female patients underwent 110 breast reconstructions with the BLBL-LAT flap. Seventy-five percent of patients had prosthesis placement and 25% of patients were 100% autologous. Complication rates were low: 4 of 106 patients (3.8%) had seroma, needing surgery. Of the 78 reconstructions with implants or tissue expanders, 3 (3.8%) had a periprosthetic infection. One (<1%) patient had partial flap loss, and no patients had complete flap loss. Four patients had bilateral BLBL-LAT flap reconstruction. Two unilateral breast reconstruction patients came back for successful symmetrizing of the bra-line back lift (without LAT flap breast reconstruction).
The BLBL-LAT flap allows breast reconstruction and simultaneous improvement of back contour, leaving a scar that can be concealed in a bra. This 2-for-1 procedure is of particular benefit to patients with a high BMI, who often have unwanted excess adiposity and laxity of the back. Because this patient population is at high risk for free tissue transfer, we propose that the BLBL-LAT flap be considered the first-line method of autologous breast reconstruction in higher BMI patients.
几十年来，背阔肌带蒂皮瓣一直是乳房重建的常用皮瓣。背部不对称的瘢痕一直是主要的不满来源。对于背部脂肪过多的患者，我们可以利用切取皮瓣来改善背部外形。我们将美学胸罩线背部提升术的原理与背阔肌皮瓣相结合，以同时改善上背部的脂肪过多和皮肤冗余问题，这两者共同形成了“背部赘肉”，并留下一条隐蔽的瘢痕。
目的是建立一种新的手术技术，即胸罩线背部提升术联合背阔肌皮瓣（BLBL-LAT皮瓣）用于美学乳房重建。
这是一项在国家癌症中心进行的、经机构审查委员会批准的、由单一外科医生进行的回顾性研究。我们纳入了2015年至2023年间接受BLBL-LAT皮瓣联合乳房重建且随访至少6个月的患者。
共有106例女性患者接受了110次BLBL-LAT皮瓣乳房重建。75%的患者进行了假体植入，25%的患者为100%自体组织重建。并发症发生率较低：106例患者中有4例（3.8%）出现血清肿，需要手术治疗。在78例植入假体或组织扩张器的重建手术中，3例（3.8%）发生了假体周围感染。1例（<1%）患者出现部分皮瓣坏死，无患者出现完全皮瓣坏死。4例患者接受了双侧BLBL-LAT皮瓣重建。2例单侧乳房重建患者因成功使胸罩线背部提升术对称（未进行背阔肌皮瓣乳房重建）而再次就诊。
BLBL-LAT皮瓣可实现乳房重建并同时改善背部外形，留下的瘢痕可隐藏在胸罩内。这种一举两得的手术方法对体重指数（BMI）较高的患者特别有益，这类患者通常背部有多余的脂肪和皮肤松弛问题。由于该患者群体进行游离组织移植的风险较高，我们建议将BLBL-LAT皮瓣视为BMI较高患者自体乳房重建的一线方法。
