Skin-sparing mini dorsi flap

Abstract

Objective: The fat-grafted latissimus dorsi muscle flap has become an excellent option for immediate or late post-mastectomy autologous breast reconstruction. The latissimus dorsi flap without skin island can be used in immediate reconstruction after skin- and nipple-sparing mastectomy, as there is no need to replace the skin on the breast. The work presented
here describes a new approach of the Mini flap of the dorsal fat graft in the total breast reconstruction after skin- and nipple-sparing mastectomy in patients with small- and medium-sized breasts, eliminating its classic scar from the removal
of the island of skin on the side of the thorax. Methodology: Initially, a skin- and nipple-sparing mastectomy is performed
through an incision in the lateral portion of the inframammary fold. Then, through the same incision, the latissimus dorsi
muscle is identified. The muscle is sectioned at its insertions and transposed to the mastectomy bed. The inferior, medial,
and superior portions (tendon) of the muscle are preserved (mini flap). Liposuction is performed on the abdominal wall
and/or thighs, and the fat graft is performed in several planes such as a skin flap from the mastectomy, intramuscular in
the pectoralis major and in the latissimus dorsi flap. Results: This new method was performed in five cases. The average
duration of the total procedure (mastectomy + axillary approach + reconstruction) was 296 min (270–330), the average
breast weight was 350 g (205–458), and the average volume of fat grafted was 234 ml (190–270). We had two cases of seroma
in the donor area. Conclusion: The lipo-filled skin-sparing mini dorsi flap allows small- and medium-sized breasts to be
completely reconstructed with autologous tissue without scarring on the back, without the need to change position, and
without the complete removal of the latissimus dorsi muscle.