Autologous reliability with prosthetic precision—the latissimus dorsi flap (LDF) is back for a reason. In this episode we break down how to optimize LD flap breast reconstruction using “volume-added” harvest and smart expander/implant strategy.
We cover the operative setup from markings and skin paddle design to subfascial dissection to capture deep fat, high axillary tunneling, and inset strategies that improve contour while protecting the pedicle. We also clarify when to use expander as an intelligent spacer vs. immediate implant—and how Stage 2 refinement (4–6 months) improves final implant selection and symmetry.

Key Takeaways:

• Markings: center the skin island on the muscle; align to relaxed skin tension lines to reduce ugly scars.

• Volume-added harvest: stay just under thoracic fascia to bring deep fat for better mastectomy-edge camouflage.

• Preserve lateral contour: respect the upper anterior “zone of adherence;” tunnel high in the axilla.

• Protect perfusion: keep serratus branch intact—critical collateral if thoracodorsal is compromised.

• Seroma is the enemy: quilting/progressive tension sutures + drains can reduce chronic drainage.

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #BreastReconstruction #LatissimusDorsiFlap #Microsurgery #PRS #Residency

Links:🎧 Full episodes available now:

Instagram: https://www.instagram.com/plasticsinpractice/

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

References :

1. Hammond DC, Loffredo MA. Latissimus Dorsi Flap Breast Reconstruction. In: [Chapter 60]. (Source file provided).

2. Rios J, Adams WP, Pollock T. Progressive tension sutures to decrease latissimus donor site seroma. Plast Reconstr Surg. 2003;112:1779. (DOI/PMID not verified from provided source.)

Prosthetic breast reconstruction looks “simple” until you chase symmetry, fight the inframammary fold, and add radiation into the mix. This episode is a practical walkthrough of the two-stage expander–implant pathway—what actually matters, what fails, and how to plan it cleanly.

Episode overview
We cover patient selection, immediate vs delayed timing, modern biodimensional expanders, the expansion protocol, and the exchange operation with an emphasis on IMF positioning, inferior pole projection/ptosis, and strategies to optimize symmetry. We also break down ADM use (what it helps, what it costs), and why radiation changes complication risk and revision rates.

Key takeaways:

• Ideal implant candidates: thin, bilateral, or thin unilateral with a nonptotic contralateral breast.

• Expansion pearls: start ~10–14 days, fill 30–120 mL per visit; overexpand ~25–30% to build skin for ptosis/projection.

• ADM: enables larger initial fills and pocket control, but can increase seroma and infection-related failure.

• Exchange: measure base width/height/projection; IMF definition is the highest-leverage step.

• Radiation: higher capsular contracture/complication rates—plan sequencing and counsel hard.

Links
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
#PlasticSurgery #BreastReconstruction #Microsurgery #SurgicalEducation #Residency #TissueExpander #ImplantReconstruction #ADM #Oncoplastic #PRS

References:

1. Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions. Plast Reconstr Surg. 2010;125(6):1606-1614. PMID: 20517083.

2. Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124(6):1772-1780. PMID: 19952633.

3. Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2004;113(3):877-881. PMID: 15108879.

4. Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. Influence of AlloDerm on expander dynamics/complications in immediate TE/I reconstruction. Ann Plast Surg. 2008;60(5):510-513. PMID: 18434824.

   
   

   
   

   Disclaimer: This content is for educational purposes only and is not medical advice.

Breast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals.

In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center.

Key takeaways:

• Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30.

• Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo).

• Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control.

• Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT.

• Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven.

Disclaimer: This content is for educational purposes only and is not medical advice.

#BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

Citations (AMA):

1. Saslow D, Boetes C, Burke W, et al. CA Cancer J Clin. 2007;57(2):75-89. doi:10.3322/canjclin.57.2.75. PMID:17392385.

2. Fisher B, Redmond C, Poisson R, et al. N Engl J Med. 1989;320(13):822-828. PMID:2927449.

3. Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786.

4. Giuliano AE, Hunt KK, Ballman KV, et al. JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90. PMID:21304082.

5. Fisher B, Costantino J, Redmond C, et al. N Engl J Med. 1993;328(22):1581-1586. doi:10.1056/NEJM199306033282201. PMID:8292119.

6. Fisher B, Dignam J, Wolmark N, et al. Lancet. 1999;353(9169):1993-2000. doi:10.1016/S0140-6736(99)05036-9. PMID:10376613.