The traditional versus endoscopic-assisted latissimus dorsi harvest in oncoplastic surgery: A long term comparison of breast volume, aesthetics, and donor site outcomes

Abstract

Background/objective: Volume replacement with the latissimus dorsi (LD) is an option for patients after partial mastectomy. Although potential benefits of using the endoscopic technique have been previously described, previous studies have not assessed long term volume and aesthetic outcomes compared to traditional methods. In this study, we aim to compare the endoscopic, latissimus only harvest to the traditional latissimus with skin paddle method.

Methods: Eleven patients underwent breast reconstruction with the traditional LD flap harvesting method; 9 underwent endoscopically assisted LD flap reconstruction. The difference between preoperative and >1 year postoperative volumes were recorded. Patient satisfaction and surgeon-based observer assessment of the breast aesthetic and donor site scar were compared between the two techniques.

Results: Compared to the traditional group, there was a significant mean volume reduction in the endoscopic group (70.3 vs 21.7 cc, p = 0.0023). Operative time was also longer in the endoscopic group than in the traditional group (368 vs 257 min, p < 0.001). In observer assessment criteria, the result of the donor site scar assessment was superior in the endoscopic group in terms of vascularity (p = 0.0038), relief (p = 0.0023), and pliability (p = 0.053).

Conclusion: Patients' attitudes and feelings about the scar were better in the endoscopic group than in the traditional group. However, compared to the endoscopic group, the traditional group achieved a better breast cosmetic result and better retention of volume postoperatively, possibly due to incorporation of the skin flap and adipo-fascial tissue.