The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery.

Breast conservation surgery is now widely accepted as the treatment of choice in early breast cancer. Randomised controlled trials have shown comparable recurrence and survival rates following breast conservation when compared to mastectomy, with the perceived advantage that it should leave a cosmetically acceptable result without reconstruction. It is our experience that an adequate local excision may result in a poor cosmetic result with distortion of the nipple position, especially in women with small breasts. Between January 1994 and July 1996, we have performed 30 procedures, combining a wide local excision and axillary lymph node clearance for breast cancer with immediate reconstruction of the defect with a latissimus dorsi musculocutaneous flap. All patients had postoperative radiotherapy to the residual breast and, where appropriate, to the axilla. Adjuvant hormonal therapy or chemotherapy was prescribed where indicated. Patient's ages ranged from 36 to 72 years. All tumours were in the lateral, superior or inferior quadrants. The mean combined operating time was 120 min. Two patients required postoperative blood transfusion. Mean hospital stay was 8 days. Histology confirmed tumour clearance in all cases and six patients had axillary lymph node metastases. There were two cases of minor wound infection and six cases of seroma at the donor site. We conclude that breast cancers are ideally treated by a multidisciplinary team and that an immediate latissimus dorsi musculocutaneous flap may correct the deformities often seen after breast conservation surgery.