World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 16, Number 6, December 2025, pages 621-629

Immediate Breast Reconstruction Using an Expanded Latissimus Dorsal Musculocutaneous Flap Without Body Position Change

Figure 1. Intraoperative images. (a) Preoperative back skin incision design. (b) Preoperative breast design. (c) Flap moved to the prothorax. (d) Flap folded in two and formed into the breast shape.

**Table 1.** Clinical and Pathological Characteristics of Breast Cancer Patients With and Without Immediate Reconstruction
	Reconstruction	Mastectomy alone	P value
BMI: body mass index; ER: estrogen receptor; Her2: human epidermal growth factor receptor 2;PgR: progesterone receptor.
Length of follow-up, months (median)	58 (0 - 124)	56 (0 - 118)	0.8423
No. of cases	223	48
Age (average)	49.7 (24 - 80)	64.1 (36 - 90)	< 0.0001
BMI (median)	21.8 (17.2 - 37.7)	20.7 (17.3 - 32.9)	0.0793
Pathology			0.0182
Ductal carcinoma in situ	53	12
Lobular carcinoma in situ	0	2
Invasive ductal carcinoma	140	24
Invasive lobular carcinoma	8	3
Others	22	7
Stage			0.6967
0	53	14
I	114	20
IIA	38	9
IIB	16	5
IIIA	2	0
ER			0.0017
Positive	182	33
Negative	41	13
Uncertain	0	2
PgR			0.0008
Positive	163	25
Negative	60	21
Uncertain	0	2
Her2			0.8873
Positive	33	6
Negative	169	37
Uncertain	21	5
Adjuvant endocrine therapy	175	29	0.0330
Adjuvant chemotherapy	24	4	0.7942
Adjuvant radiotherapy	3	1	< 0.0001
Smoking	22	6	< 0.0001
Diabetes	10	4	< 0.0001

Table 1. Clinical and Pathological Characteristics of Breast Cancer Patients With and Without Immediate Reconstruction

Reconstruction

Mastectomy alone

P value

BMI: body mass index; ER: estrogen receptor; Her2: human epidermal growth factor receptor 2;PgR: progesterone receptor.

Length of follow-up, months (median)

58 (0 - 124)

56 (0 - 118)

0.8423

No. of cases

223

Age (average)

49.7 (24 - 80)

64.1 (36 - 90)

< 0.0001

BMI (median)

21.8 (17.2 - 37.7)

20.7 (17.3 - 32.9)

0.0793

Pathology

0.0182

Ductal carcinoma in situ

Lobular carcinoma in situ

Invasive ductal carcinoma

140

Invasive lobular carcinoma

Others

Stage

0.6967

114

IIA

IIB

IIIA

0.0017

Positive

182

Negative

Uncertain

PgR

0.0008

Positive

163

Negative

Uncertain

Her2

0.8873

Positive

Negative

169

Uncertain

Adjuvant endocrine therapy

175

0.0330

Adjuvant chemotherapy

0.7942

Adjuvant radiotherapy

< 0.0001

Smoking

< 0.0001

Diabetes

< 0.0001

**Table 2.** Comparisons of Operation Time, Blood Loss, and Surgery Method of Breast Between Our Study and Report by Sakai et al [15]
	Our study	Sakai et al [15]
Ax: axilla dissection; NSM: nipple-sparing mastectomy; SNB: sentinel lymph node biopsy; SSM: skin-sparing mastectomy.
No. of cases	223	174
Operation time (median), min	183.6 (115 - 191)	418
Blood loss (median), mL	73.2 (5 - 322)	618
Surgery method of breast
NSM	107	2
NSM + SNB	85	2
NSM + SNB → Ax	9	0
NSM + Ax	7	0
NSM + SNB → SSM	1	0
NSM + SNB → SSM + Ax	1	0
SSM + SNB	5	108
SSM + SNB → Ax	1	0
SSM+Ax	1	51

Table 2. Comparisons of Operation Time, Blood Loss, and Surgery Method of Breast Between Our Study and Report by Sakai et al [15]

Our study

Sakai et al [15]

Ax: axilla dissection; NSM: nipple-sparing mastectomy; SNB: sentinel lymph node biopsy; SSM: skin-sparing mastectomy.

No. of cases

223

174

Operation time (median), min

183.6 (115 - 191)

418

Blood loss (median), mL

73.2 (5 - 322)

618

Surgery method of breast

NSM

107

NSM + SNB

NSM + SNB → Ax

NSM + Ax

NSM + SNB → SSM

NSM + SNB → SSM + Ax

SSM + SNB

108

SSM + SNB → Ax

SSM+Ax

**Table 3.** Complication With Immediate Reconstruction
	No. of cases	% (N = 130/223)	Sakai et al [15]
No. of total complication	130/223 (58.3%)		120/174 (69.0%)
Complication
Donor site seroma	103	79.2/46.2	71 cases (41%)
Wound detachment	9	6.9/4.0	43 cases (24.6%)
Nipple necrosis	8 (partial only)	6.2/3.6	Four cases (2.3%)
Flap infection	5	2.0/2.2	One case (0.5%)

Table 3. Complication With Immediate Reconstruction

No. of cases

% (N = 130/223)

Sakai et al [15]

No. of total complication

130/223 (58.3%)

120/174 (69.0%)

Complication

Donor site seroma

103

79.2/46.2

71 cases (41%)

Wound detachment

6.9/4.0

43 cases (24.6%)

Nipple necrosis

8 (partial only)

6.2/3.6

Four cases (2.3%)

Flap infection

2.0/2.2

One case (0.5%)

**Table 4.** Risk Factor of Seroma
Characteristics	HR (95% CI)	P-value
BMI: body mass index; CI: confidence interval; HR: hazard ratio.
Age > 50 years	0.529	0.0202
BMI > 21.5 kg/m²	0.394	0.0007
Operation time > 173 min	0.582	0.0505

Table 4. Risk Factor of Seroma

Characteristics

HR (95% CI)

P-value

BMI: body mass index; CI: confidence interval; HR: hazard ratio.

Age > 50 years

0.529

0.0202

BMI > 21.5 kg/m²

0.394

0.0007

Operation time > 173 min

0.582

0.0505

**Table 5.** Aesthetic Grading Results of Breast Reconstruction
Aesthetic grade	No. of cases	%	Du et al [17], %	Adel et al [18], %
Excellent	153	68.6	58.7	60.8
Good	55	24.7	30.2	30.0
Fair	7	3.1	7.9	7.1
Poor	1	0.4	3.2	2.1
Uncertain	7	3.1	0.0	0.0

Table 5. Aesthetic Grading Results of Breast Reconstruction

Aesthetic grade

No. of cases

Du et al [17], %

Adel et al [18], %

Excellent

153

68.6

58.7

60.8

Good

24.7

30.2

30.0

Fair

3.1

7.9

7.1

Poor

0.4

3.2

2.1

Uncertain

3.1

0.0