Pedicled latissimus dorsi flap for closure of a chronic postmastectomy breast defect in a previously irradiated patient: a case report Postmastectomy Defect Reconstruction

Abstract

Background: Breast cancer remains the most frequently diagnosed malignancy in women worldwide, with an estimated 2.3 million new cases and 670,000 deaths reported in 2022. Mastectomy continues to play a central role in treatment; however, postoperative soft-tissue defects are not always amenable to primary closure, particularly after large resections, repeated surgery, or prior radiotherapy. The latissimus dorsi flap, first described by Tansini and later reintroduced by Olivari in 1976, remains a well-established reconstructive option. 

Case presentation: We report a 57-year-old woman with type 2 diabetes mellitus who presented with a persistent, non-healing 4 × 12 cm soft-tissue defect at the lower pole of the right breast following oncologic treatment for invasive breast carcinoma. The patient subsequently underwent adjuvant chemotherapy and radiotherapy. Despite three months of conservative wound care after mastectomy, the defect failed to heal adequately, consistent with a compromised post-radiation wound environment. Delayed reconstruction was performed using an ipsilateral pedicled latissimus dorsi myocutaneous flap, achieving complete defect coverage and tension-free closure. At 4-week follow-up, the flap remained viable with complete wound healing and no postoperative complications.

Conclusion: The pedicled latissimus dorsi flap provides effective vascularized tissue coverage for chronic postmastectomy defects in irradiated fields, particularly when local tissue quality is poor.