Pneumothorax following extended latissimus dorsi flap breast reconstruction: Rare complication or coincidence?

摘要

Dear Sir, The extended latissimus dorsi (ELD) flap has become popularised as one of the available flaps to use in autologous breast reconstruction. It is robust, reliable, and is able to offer good breast volume and shape with satisfactory aesthetic outcome. The commonest reported complication of latissimus dorsi flap breast reconstruction relate to donor site morbidity, namely seroma formation. Other donor site morbidities include contour deformity and haematoma. The latissimus dorsi flap itself is an extremely reliable flap, with a low incidence of necrosis. We describe a series of patients, whom developed pneumothoraces following immediate extended latissimus dorsi flap breast reconstruction as part of their breast cancer treatment. A retrospective review of 749 ELD flap breast reconstructions performed over a 15-year period (between 1997 and 2012) identified the three cases described in this series (0.4%). As with any low incidence complication, the possible association between pneumothorax and ELD flap breast reconstruction could be easily overlooked, thus leading to potential under-reporting in the literature. All three female patients presented with symptomatic breast lumps, confirmed to be invasive ductal carcinomas by core biopsies. They elected to have a skin-sparing mastectomy with an immediate ELD flap breast reconstruction as part of their cancer treatment (Table 1). Patients 1 and 2 had negative upfront sentinel lymph node biopsies. Patient 3 had axillary lymph node metastasis at diagnosis and thus proceeded to an axillary nodal clearance at the time of her reconstructive surgery.