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Lower loss rate seen in obese patients after latissimus flap plus tissue expander reconstruction

Among morbidly obese patients, researchers found a lower expander loss rate and lower incidence of infection in those who underwent immediate postmastectomy reconstruction using a latissimus flap plus tissue expander compared with those who underwent reconstruction with a tissue expander alone.

The retrospective study utilized previously published data from 346 patients (511 breasts) who underwent immediate prosthetic reconstruction with a two-stage approach using a submuscular tissue expander or tissue expander-acellular dermis, followed by placement of a permanent implant.

Those with a BMI greater than 35 were considered morbidly obese, which classified 49 patients (67 breasts). A total of 21 morbidly obese patients (22 breasts) underwent immediate reconstruction following postmastectomy with latissimus flap and tissue expander.

Average BMI, patient age, and the risk profile for diabetes and tobacco use were similar between groups.

Morbidly obese patients reconstructed with a tissue expander alone with the use of acellular dermis (ACD) had a rate of prosthesis loss of 18%, which did not vary significantly from the patients reconstructed with tissue expander without ACD at 23.5%. As a result, the researchers combined these two groups into a single cohort for the remainder of the study.

The tissue expander-only group had a higher rate of seroma at 58.2% vs. the latissimus group at 18.2%, which the researchers considered to be a statistically significant difference. However, the rate of postoperative skin necrosis was found to be similar between the two groups.

Tissue expander loss was significantly less in the latissimus group at 4.5% compared with the tissue expander-only group at 19.4%.

The biggest patient-reported disadvantage to the latissimus flap is the incisional scar, according to the researchers. - by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.