An Algorithmic Approach to Breast Reconstruction Using Latissimus Dorsi Musculocutaneous Flaps

Sir: We read with interest the article by Durkin et al.1 entitled “An Algorithmic Approach to Breast Reconstruction Using Latissimus Dorsi Musculocutaneous Flaps.” We congratulate the authors for an excellent systematic evaluation of potential techniques for latissimus dorsi breast reconstruction in patients with a variety of mastectomy defects and risk factors. Their logical approach is well structured in the planning of reconstruction for mastectomy defects with respect to the inframammary fold and designing the skin pedicle accordingly. However, we would like to highlight the role of the muscle-sparing latissimus dorsi musculocutaneous flap as an addition to the algorithm, as it would offer more choices to patients for reconstructive options and decrease the complications encountered with traditional latissimus dorsi flaps. The muscle-sparing latissimus dorsi technique for breast reconstruction has recently been described,2,3 and we have been using this technique for breast reconstruction for the past 3 years. One of the principal drawbacks of the conventional latissimus dorsi flap is donor-site seroma formation. This complication is nearly completely eliminated when preserving the bulk of the muscle in situ and reduces patient hospital stay, as the drains come out earlier. We agree with and support the authors on the use of an algorithmic approach to breast reconstruction. We also believe that the muscle-sparing latissimus dorsi technique is an additional tool for breast reconstruction and offers patients and surgeons more choices. Its inclusion as an option would certainly strengthen the authors' algorithm. Anuj Mishra, M.R.C.S. Philip Brackley, Ph.D., F.R.C.S.(Plast.) Mandana Sigroudinia, M.R.C.S. Azhar Iqbal, F.R.C.S.(Plast.) Department of Plastic and Reconstructive Surgery Whiston Hospital Liverpool, United Kingdom