{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:18:39Z","timestamp":1765232319987},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":2241,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2016,3,18]],"date-time":"2016-03-18T00:00:00Z","timestamp":1458259200000},"content-version":"tdm","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>\nBackground  The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant.<\/jats:p><jats:p>\nMethods  We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant.<\/jats:p><jats:p>\nResults  The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry.<\/jats:p><jats:p>\nConclusions  This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.<\/jats:p>","DOI":"10.5999\/aps.2016.43.2.197","type":"journal-article","created":{"date-parts":[[2016,3,23]],"date-time":"2016-03-23T04:47:05Z","timestamp":1458708425000},"page":"197-203","update-policy":"http:\/\/dx.doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right"],"prefix":"10.1055","volume":"43","author":[{"given":"Jiajun","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cleone I","family":"Pardoe","sequence":"additional","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley Manuel","family":"Mota","sequence":"additional","affiliation":[{"name":"Hull and East Yorkshire Trust, England, Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher Hoe Kong","family":"Chui","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bien-Keem","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s00266-002-2034-6","article-title":"Achieving symmetry in unilateral breast reconstruction: 17 years experience with 683 patients","volume":"26","author":"PL Giacalone","year":"2002","journal-title":"Aesthetic Plast Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1097\/00006534-199404000-00024","article-title":"Improving the latissimus dorsi myocutaneous flap with tissue expansion","volume":"93","author":"SA Slavin","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/S0360-3016(99)00215-1","article-title":"Validation of the methods of cosmetic assessment after breast-conserving therapy in the EORTC \"boost versus no boost\" trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer","volume":"45","author":"C Vrieling","year":"1999","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.cps.2006.11.008","article-title":"Latissimus dorsi flap breast reconstruction","volume":"34","author":"DC Hammond","year":"2007","journal-title":"Clin Plast Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/00006534-199603000-00004","article-title":"Breast reconstruction with the extended latissimus dorsi flap","volume":"97","author":"G Germann","year":"1996","journal-title":"Plast Reconstr Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1054\/bjps.1998.3045","article-title":"Extended latissimus dorsi musculocutaneous flap for breast reconstruction: experience in Oriental patients","volume":"52","author":"JW Lee","year":"1999","journal-title":"Br J Plast Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.ejso.2013.07.001","article-title":"Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery","volume":"39","author":"R Bonomi","year":"2013","journal-title":"Eur J Surg Oncol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"104S","DOI":"10.1097\/PRS.0b013e31825f2538","article-title":"Focus on technique: two-stage implant-based breast reconstruction","volume":"130","author":"JY Kim","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1097\/GOX.0000000000000248","article-title":"Tissue expander versus tissue expander and latissimus flap in morbidly obese breast reconstruction patients","volume":"3","author":"EA Luce","year":"2015","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/PRS.0b013e3181c49458","article-title":"Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue","volume":"125","author":"JM Serra-Renom","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00238-014-0952-6","article-title":"Breast reconstruction by tissue expander after radiotherapy: when the skin does not expand, the rib cage is at risk","volume":"37","author":"H Alani","year":"2014","journal-title":"Eur J Plast Surg"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.e-aps.org\/upload\/pdf\/aps-43-197.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.e-aps.org\/journal\/view.php?doi=10.5999\/aps.2016.43.2.197","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.5999\/aps.2016.43.2.197.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T23:38:28Z","timestamp":1650497908000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.5999\/aps.2016.43.2.197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3]]},"references-count":11,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2022,4,20]]},"published-print":{"date-parts":[[2016,3]]}},"URL":"https:\/\/doi.org\/10.5999\/aps.2016.43.2.197","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3]]},"assertion":[{"value":"2015-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-11-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-03-18","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-03-15","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}