ABSTRACT:

Endoscopy-assisted harvesting of Latissimus Dorsi flap for breast reconstruction

Numerous oncoplastic breast surgeons prefer to use a latissimus dorsi (LD) muscle flap for breast reconstruction after partial or total mastectomy. The conventional technique for harvesting of LD flap remains large scar on patient’s ipsilateral back. Herein, I introduce an endoscopy-assisted LD flap harvesting technique as a novel procedure. Fiive consecutive patients with breast cancer underwent breast reconstruction using pedicled LD flap after partial mastectomy under endoscopy-assisted technique. The LD flap was harvested under endoscopy-assisted technique with 4-6 cm of vertical incision on mid axillary line and breast reconstruction was followed as conventional LD reconstruction technique.
The mean operation time for LD flap harvesting was 135.0 minutes including skin closure and the mean total operating time was only 243.5 minutes. All cases showed successful LD flap harvest under single incision and the patients discharged without major complication. There was no donor-site hematoma or consistent seroma and the cosmetic results were good based on the patient’s satisfactory scores.
Endoscopy-assisted LD flap harvest would be a novel and effective technique with better cosmetic results than conventional technique. And if breast surgeon can perform both breast surgery and reconstruction by himself, the operation time would be reduced.

Impact of minimal access surgery on breast surgeon & patients

“Minimal invasive surgery (MIS)” or “Minimal access surgery” can be defined that the surgeon uses telescopes instead of bare human eyes through small incision or natural orifices of body to treat disease.
Breast is a visible symbols which represents femininity, the cosmetic outcomes after surgery had been regarded as more important than other organs. However, the concept of oncoplastic breast surgery (OPS) has focused on breast shape and symmetry, but not on scars and incisions. Because the obtaining of space within breast is difficult, laparoscopic or endoscopic surgery could not be applied for breast surgery so far.
The survival rate of breast cancer is longer than other malignancies and the physicians have responsibilities to improve the patients’ quality of life. That’s why we need to apply the minimal access surgery to breast cancer. However, when a new surgical technique is emerging, a learning a new surgical technique would be stressful to surgeons and it takes a lot of time and efforts. And until the surgeon feel comfortable, it would be a big challenge especially to senior surgeons because the endoscopic or robotic devices gives a strain on finger and wrist joints.
This surgical concept will give more benefits including breast shape, small and invisible postoperative scars and early recovery to patients with breast cancer. From this paradigm shifting of surgical procedure may lead the changes in social awareness for patients with breast cancer and the patients will be able to return to daily social life with more confidence in body images. And after the cancer surveillance of breast cancer is completed, they can maintain their healthy psychosocial functions and self-esteems.