Background

Oncoplastic techniques enabled performing breast conserving surgery (BCS) to larger tumors. Mini latissimus dorsi flap (MLDF) is a novel approach promising successful cosmetic outcome after wide excisions for breast cancer surgery. The aims of this study are to evaluate the effect of MLDF on BCS rate in early stage breast cancer patients, and to compare patient and tumor characteristics between BCS patients with and without MLDF.

Patients and Methods

Data of early stage breast cancer patients (cT1-3N0-1M0) operated between years 2005 and 2015 were prospectively collected. We started to perform MLDF after 2010, and 157 consecutive patients who underwent BCS + MLDF reconstruction composed the study group. To prevent any selection bias, we comprised the control group from patients, who underwent BCS before our clinic started performing MLDF. 152 tumor stage-matched patient underwent BCS before 2010 composed the control group. The MLDF reconstruction was performed after lumpectomy and sentinel lymph node biopsy and/or axillary dissection via axillary incision. The volume of prepared latissimus dorsi muscle flap was depended on volume of the tumor cavity. Ink on the tumor in the specimen was accepted as negative positive surgical margin. All patients took whole breast and boost radiation. Systemic treatment decision was given after assessment of patients on the tumor conference.

Results

Between 2005 and 2015 data on 994 patients who underwent BCS were prospectively gathered with 371 patients registered in between 2005-2009 and 631 patients in between 2010-2015. The BCS rate increased from 66.5% to 78% after our clinic started performing MLDF in 2010 with MLDF rate being nearly 12%. The mean age and the mean body mass index were higher in the control group (54.2 vs. 46.7, p<0.001 and 27.85 kg/m2 vs. 25.01 kg/m2, p<0.001, respectively). Mean tumor size was larger in the study group (27.8 mm vs. 21.0 mm, p<0.001). Multifocality rate was higher in the study group (26.75% vs. 9.79%, p=0.001). Early complications (seroma, prolonged wound drainage, wound infection, hematoma, wound dehiscence) rates were similar in both groups (Table 1).

Table 1. Patient and tumor characteristics.

  Study group (n=157) Control group (n=152) 
Age (y) 46.66±10.35 (28-83) 54.17±11.18 (30-85) <0.001 
Age <40 years old (%) 26.1 9.1 <0.001 
BMI* (kg/m2) 25.01±3.55 (19.6-43.0) 27.85±4.74 (20.0-41.2) <0.001 
Right upper quadrant (%) 73.2 56.6 0.023 
Tumor size (mm) 27.84±16.68 (1=100) 21.04±11.19 (4-70) <0.001 
Surgical margin width (mm) 6.91±4.58 (1-25) 8.17±4.11 (1-20) 0.010 
Number of metastatic lymph nodes 3.17±5.32 (0-30) 1.39±2.97 (0-16) 0.030 
pN0 rate (%) 44.59 68.53 <0.001 
Multifocality rate (%) 26.75 9.79 <0.001 
Morbidity rate (%) 8.3 3.5 0.081 
  Study group (n=157) Control group (n=152) 
Age (y) 46.66±10.35 (28-83) 54.17±11.18 (30-85) <0.001 
Age <40 years old (%) 26.1 9.1 <0.001 
BMI* (kg/m2) 25.01±3.55 (19.6-43.0) 27.85±4.74 (20.0-41.2) <0.001 
Right upper quadrant (%) 73.2 56.6 0.023 
Tumor size (mm) 27.84±16.68 (1=100) 21.04±11.19 (4-70) <0.001 
Surgical margin width (mm) 6.91±4.58 (1-25) 8.17±4.11 (1-20) 0.010 
Number of metastatic lymph nodes 3.17±5.32 (0-30) 1.39±2.97 (0-16) 0.030 
pN0 rate (%) 44.59 68.53 <0.001 
Multifocality rate (%) 26.75 9.79 <0.001 
Morbidity rate (%) 8.3 3.5 0.081 

Conclusion

The MLDF significantly increased breast conserving surgery rate in patients with early stage breast cancer. It should be considered in patients with young age (<40 years), having large and multifocal tumors.

Data are presented as mean±SD [range] unless noted otherwise

*BMI: body mass index.

Citation Format: Ozmen V, Sarsenov D, Ozmen T, Ilgun S, Alco G, Ordu C, Agacayak F, Elbuken F, Erdogan Z, Pilanci KN. Mini latissimus dorsi flap increases breast conserving surgery rate in early stage breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-17.