Total muscular implant coverage in alloplastic breast reconstruction

Share Favorites Permissions LETTERS Total Muscular Implant Coverage in Alloplastic Breast Reconstruction Bonomi, Stefano M.D.; Salval, Andrè M.D.; Settembrini, Fernanda M.D.; Sorbi, Flavia M.D.; Gregorelli, Chiara M.D.Author Information Plastic and Reconstructive Surgery: March 2012 - Volume 129 - Issue 3 - p 552e-554e doi: 10.1097/PRS.0b013e318241ae41 FREE Metrics Sir: Figure Figure It was with great pleasure that we read the interesting article by Elliott et al.,1 recently published in this Journal, and we would like to congratulate the authors on their study. The authors described the use of the “scarless” latissimus dorsi flap to provide total well-vascularized coverage to implant or tissue expander in conjunction with pectoralis major muscle. The traditional tissue expander or implant placement requires complete muscular coverage by elevating both the pectoralis major and the serratus anterior. We agree with the authors that it is important to have vascularized and adequate coverage when implanting devices, but we believe that sacrifice of a large muscle such as the latissimus dorsi is not always justified, especially if radiotherapy has not been performed. The latissimus dorsi should be used for implant coverage in case of previous radiotherapy to reduce the risk of capsular contracture; otherwise, the serratus anterior combined with the pectoralis major muscle usually provides full muscular coverage to the device, especially in the event of a partially inflated tissue expande