Editor - Dixon et al described a technique of excision of large volumes of breast tissue followed by early reconstruction with a latissimus dorsi muscle flap. 1 In their article they stated that the top figure showed no obvious resultant defect following removal of the latissimus dorsi muscle.
The latissimus dorsi muscle is one of the most frequently used flaps in reconstructive surgery. Harvest of the muscle with its overlying fat for breast reconstruction is not new.2 Russell et al have shown that all patients have obvious flattening of the soft tissue over the posteriolateral chestwall on the donor side.3 The posterior axillary fold is usually reduced or flattened.
Only an oblique view of the right side of the back is shown in their article. This illustration is not adequate to show a defect. The back of the patient should have been shown to allow comparison with the unoperated side. Care should be taken in using photographic evidence. The British Medical Journal should encourage authors to use appropriate views if any firm conclusions are to be drawn about results of treatment.
As the NHS moves into a new era of clinical excellence patients should not be given the impression of high expectation of surgery without stressing the drawbacks.
Kenneth E. Graham, Specialist Registrar.
Arthur M. Morris, Consultant Plastic Surgeon.
Department of Plastic Surgery, Dundee Royal Infirmary, Dundee DD1 9ND.
1 Dixon JM, Venizelos B, Matheson L. New technique has excellent cosmetic results. BMJ 1998; 317: 209-210. (18 July).
2 Germann G, Steinau H-U. Breast reconstruction with the extended latissimus dorsi flap. Plast. Reconstr. Surg. 1996; 97: 519-26.
3 Russell RC, Pribaz J, Zook EG, Leighton WD, Eriksson E, Smith CJ. Functional evaluation of latissimus dorsi donor site. Plast. Reconstr. Surg. 1986; 78: 336-344.
Competing interests: No competing interests