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Abstract
Purpose
A lateral thoracodorsal fasciocutaneous flap (LTFF) is a local fasciocutaneous flap that has been used in breast reconstructions since the 1980s. Although the LTFF is a well-studied reconstruction procedure after radical surgery in Western countries, there is no report in Korea. By introducing the LTFF procedure, we suggest an easy reconstruction technique that can be performed by the breast surgeon directly.
Methods
Patients with lateral breast cancer and redundant lateral thoracic region might be candidates for this procedure. The flap consists of the lateral and dorsal extensions of the inframammarian fold as well as an extended line from the anterior axillary line. A quadrantectomy is performed through a planned skin incision, and an axillary lymph node dissection can be performed simultaneously if the sentinel lymph node is positive. The skin and subcutaneous fat with the fascia of the serratus anterior and latissimus dorsi muscle should be dissected carefully. A wedge-shaped flap can be acquired successfully. The lateral breast defect is then reconstructed by a rotation of the flap. The axis of the flap is drawn following the inframammarian fold so that the final scar would be under the brassiere line.
Results
Nineteen patients were treated with the LTFF after breast conserving surgery. All tumors were located in lateral breast regions. Seroma occurred in three and partial fat necrosis and partial flap necrosis were observed in each one. The cosmetic result based on four-point scoring system of breast cosmesis showed excellent in seventeen and good in two.
Figures and Tables
 | Fig 1Flap design. The design of flap is consisted of the lateral and dorsal extensions of the inframammarian fold and a line extended from the anterior axillary line. The extension of the inframammarian fold can reach the posterior thoracic region, and extension of the anterior axillary line is designed more obliquely with curved border.
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 | Fig 2Resected breast cancer. Quadrantectomy and axillary lymph node dissection, if sentinel lymph node biopsy is positive, is performed through a planned skin incision.
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 | Fig 3The prepared lateral thoracodorsal fasciocutaneous flap. The skin and subcutaneous fat with fascia of serratus anterior and latissimus dorsi muscle are carefully dissected. We can acquire the wedge-shaped LTFF. Vascular feeding of the flap is from the fascia of underlying muscles. The careful dissection from the underlying muscles may protect the partial flap loss and fat necrosis.
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 | Fig 4Completed reconstruction. A lateral breast defect is reconstructed by a rotation of LTFF. The LTFF axis is drawn following the inframammarian fold, so that the final scar will be under the brassiere line.
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