Skin-sparing mini dorsi flap

Objective: The fat-grafted latissimus dorsi muscle flap has become an excellent option for immediate or late post-mastectomy autologous breast reconstruction. The latissimus dorsi flap without skin island can be used in immediate reconstruction after skin- and nipple-sparing mastectomy, as there is no need to replace the skin on the breast. The work presented here describes a new approach of the Mini flap of the dorsal fat graft in the total breast reconstruction after skin- and nipple-sparing mastectomy in patients with small- and medium-sized breasts, eliminating its classic scar from the removal of the island of skin on the side of the thorax. Methodology: Initially, a skin- and nipple-sparing mastectomy is performed through an incision in the lateral portion of the inframammary fold. Then, through the same incision, the latissimus dorsi muscle is identified. The muscle is sectioned at its insertions and transposed to the mastectomy bed. The inferior, medial, and superior portions (tendon) of the muscle are preserved (mini flap). Liposuction is performed on the abdominal wall and/or thighs, and the fat graft is performed in several planes such as a skin flap from the mastectomy, intramuscular in the pectoralis major and in the latissimus dorsi flap. Results: This new method was performed in five cases. The average duration of the total procedure (mastectomy + axillary approach + reconstruction) was 296 min (270–330), the average breast weight was 350 g (205–458), and the average volume of fat grafted was 234 ml (190–270). We had two cases of seroma in the donor area. Conclusion: The lipo-filled skin-sparing mini dorsi flap allows small- and medium-sized breasts to be completely reconstructed with autologous tissue without scarring on the back, without the need to change position, and without the complete removal of the latissimus dorsi muscle.