A modified design of latissimus dorsi myocutaneous flap for patients with high mastectomy scars
Several options available for breast reconstruction have been shown to lessen the psychological disturbances associated with mastectomy. Among these, the latissimus dorsi myocutaneous flap is a safe and reliable technique. It provides a good environment for an implant, and the mechanics of flap elevation and inset have become routine. The level and position of the mastectomy scar may affect the aesthetic result of the reconstruction technique. The aesthetic quality of the new breast depends on a few key planning considerations, one of which is the flap inset. A high mastectomy scar prevents an ideal flap inset, causing a reduced horizontal length of the lower skin. In the late postoperative period, the new breast mound gains an unaesthetic projected appearance on the retained skin envelope, because of the “trap door” deformity caused by contracture of the lower breast skin flap. To overcome these problems, we added a triangular flap to the latissimus dorsi skin flap (Fig. 1). It increased the horizontal length of the lower skin flap and reduced the skin contracture, thereby having a Z plasty effect (Fig. 2). Moreover, it reduced the donor site morbidity, especially in cases where we planned a wider flap, because it eased the closure of the donor site ( Fig. 3). Finally, we would like to emphasize that adding a triangular skin flap to the latissimus dorsi myocutaneous flap provides a desired breast shape in cases of high mastectomy scars and reduces donor-site morbidity.