Patient History: This 52 year old women underwent a lumpectomy for left breast cancer. Though her cancer was fully treated, the resultant scarring and contracture of tissue was unslightly and painful. She was constantly uncomfortable under left breast. Implants alone were not a good choice after lumpectomy, skin removal and radiation. To better treat our patient the patient and Dr. Goldberg chose a more comprehensive solution using her own muscle tissue. She underwent a left latissimus dorsi flap with a silicone breast implant. The right side underwent a breast augmentation with a silicone breast implant for symmetry and patient choice.
Discussion: In an ideal setting we would be have simple solutions to breast reconstruction who have lumpectomy surgery or mastectomy surgery for breast cancer. More complex options are needed for patients who have big excisions and radiation for breast cancer. Implants alone in breast reconstruction are NOT the same as implants in cosmetic augmentation. Patient’s need to understand the difference. In augmentation, the patient has the implants under here own breast tissue. This coverage of healthy skin and natural breast helps camouflage the implant. However, in cancer patients, tissue is removed including skin and breast, and they often have radiation changes which make reconstruction challenging. In my view, radiation is like putting a wool sweater in the dryer. The skin can shrink, get tight, firm and cause long term challenges for soft tissue like the breast.
This patient works full time in a very physical job. She could not tolerate the constant discomfort associated with the scarring from her cancer surgery and radiation. A good reconstruction option for her was to bring in soft healthy tissue as a flap. We used the latissiumus dorsi flap from her left side. The latissimus muscle with it’s overlying skin is soft, robust and is technically a very safe and easier flap to complete. You can see on the side view that virtually all the lower part of the patients original breast was excised and replaced by our healthy latissimus flap. We added a breast Implant under the flap muscle for added volume and enhancement. The result looks very acceptable, the patient is happy and she has no pain. She’s back to full time work.