The AAPS 101st Annual Meeting

What Nipple Reconstruction Can Tell Us About The Latissimus Dorsi Flap Subdermal Plexus

Helen S. Zitkovsky, MD, Natalie L. Kuhn, MD, and Lifei Guo, MD, PhD

Lahey Hospital and Medical Center, Burlington, MA

Background:

•Surgical nipple reconstruction is commonly assumed to be more reliable on flap beds than on mastectomy skin over implants.

•Rate of partial nipple necrosis has been described as high as 13 to 29%.

Objective: Evaluate rates of and factors contributing to partial nipple reconstruction necrosis among various breast mound reconstructive modalities.

Methods:

•Retrospective review (2012- 2022)

•Primary C-V pedicle flap nipple reconstructions

•Non-primary reconstructions excluded

•Starting 2021, all reconstructions on latissimus flaps were based laterally

•Patient demographics, C-V flap orientation, history of radiation, and postoperative nipple necrosis recorded

Latissimus dorsi flap design:

•Skin paddle vertically centered along posterior axillary line

•However, no portion of skin paddle sits off the muscle

•Advantages: Hides donor scar, requires less rotation of skin paddle

Results:

•No difference between smoking or diabetes history between groups

•No latissimus flap breast mounds were radiated

•Almost 10-fold greater risk of nipple reconstruction skin edge necrosis over latissimus breast mound compared to mastectomy skin over implant reconstruction

•This is despite many radiated breast mounds in the prosthetic groups

•Traditional superiorly-based pedicle of C-V flap on latissimus mound demonstrates a significantly higher risk of necrosis, 36.8%

•Risk of necrotic events decreases almost 5-fold laterally-based design

Conclusions:

Although more cases needed to have equivalent group comparisons:

•Anatomically conceivable that latissimus dorsi subdermal plexus may have more polarity than breast and abdominal skin flaps

•Appears safer to orient C-V flap laterally on latissimus dorsi breast mounds

The AAPS 101st Annual Meeting

What Nipple Reconstruction Can Tell Us About The Latissimus Dorsi Flap Subdermal Plexus

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