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Robotic Latissimus Harvest For Implant Coverage In The Setting Of Pre-mastectomy Radiation: A New Treatment Paradigm And Case Series
Nicole E. Speck, MD1, Mark W. Clemens, MD
1, Jesse C. Selber, MD, MPH
2, J. Bryce Olenczak, MD
1, Rene D. Largo, MD
1, Alexander F. Mericli, MD
1, Donald P. Baumann, MD
1, John W. Shuck, MD
1.
1MD Anderson Cancer Center, Houston, TX, USA,
2Corewell Health, Detroit, MI, USA.
PURPOSE: Robotic-assisted latissimus dorsi (RALD) harvest is described for device support with post-masctectomy radiotherapy (PostMRT). Current trials in pre-mastectomy radiotherapy (PreMRT) may represent a paradigm shift given significant time reduction treatment. PreMRT patients undergo mastectomy and immediate DIEP reconstruction at 3-5 weeks post-radiation. We present our current series of robotic-assisted LD harvest and device-based reconstruction with both Pre and PostMRT.
METHODS: A retrospective chart review was performed including all patients who received implant-based reconstruction with RALD harvest following either PostMRT or PreMRT from 2011 to 2025. Primary outcomes were device infection and reconstructive failure. Secondary outcomes included complications according to Clavien Dindo, flap failure rates, and robotic-associated parameters.
RESULTS: 49 patients were included with 45 and 4 receiving PostMRT and PreMRT, respectively. Mean age was 49.6 years, mean BMI was 23.8 kg/m
2, with mean follow-up of 30.6 months. Between PostMRT and PreMRT, device infection occurred in 7/45 (15%) and 0/4 (0%), respectively. Device failure was 2/45 (4.4%) and 0/4 (0%). No LD flap loss occurred and there were no conversions to open
. Mean duration of surgery was 375.7 minutes across both cohorts.
CONCLUSION: This is the largest study of RALD to date and first to describe its potential role in PreMRT. This represents a potential emerging application in the setting of patient centered and minimally invasive oncologic care at our institution with PreMRT and robotic-assisted nipple sparing mastectomy.
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