What is a Latissimus Flap Reconstruction?
Latissimus dorsi based breast reconstruction involves using tissue from your back to rebuild a breast mound. When back tissue is used, the muscle from your back, known as the latissimus dorsi muscle, and a portion of the skin and fat overlying this muscle (called the skin paddle), are taken. This procedure is called a latissimus dorsi (LD) flap. The tissue from your back is removed and moved to the front of your chest, with the blood supply still attached and therefore is called a “pedicled” flap. Since most women do not have enough fatty tissue on their back to recreate an entire breast using only the LD flap, an implant (silicone or saline) or tissue expander (temporary implant that can be filled with saline in the clinic) is commonly placed under the flap. The skin paddle will be placed in the area where the nipple and areola are removed during your mastectomy if a skin sparing mastectomy is performed or may be a larger “patch” of skin if more skin is removed or needed.
What happens during a Latissimus Flap?
This operation has two surgical sites. This means two areas for scarring and potential complications: one on the breast and one at the site where the tissue is taken on your back. The tissue must have a healthy blood supply to keep the tissue alive. Smoking, diabetes and other health problems may prevent a patient from having these procedures. Also, these procedures use your own tissue which can change over time, as well as enlarge or shrink as you gain and lose weight.
The location of the incision on your back will depend on the amount of skin that is needed to replace the skin removed during the mastectomy. Often, the incision and resulting scar can be placed so that your bra will hide the scar. Rotating the tissue from the back to the chest will result in a bulky area underneath the armpit along your chest wall. This will decrease over time but may never completely disappear.
An additional surgery may be needed to replace a tissue expander that was placed under the LD flap with a permanent silicone or saline implant. In addition, a surgical procedure (ie. augmentation, mastopexy, or breast reduction) to your other breast may be necessary to achieve symmetric appearing breasts. Remember that implants may need replaced in the future. The LD flap may also be used after breast conservation surgery to fill the misshapen area that can result after removal of the breast tissue. Patients generally have no major long-term problems from using the latissimus dorsi muscle and can resume activities of daily living and exercise just the same as before surgery. However, some patients may notice some shoulder weakness and may require physical therapy.
Patients who may consider this option are patients who want a more natural appearing breast reconstruction rather than an implant alone, do not mind other scars on their body, are thin and do not have abdominal tissue to use, have had prior radiation, and want a potentially single stage procedure.
Questions to Ask Your Surgeon
- Would I be a candidate for latissimus dorsi reconstruction?
- How many surgeries will I need?
- How will this match my breast that does not have cancer? Will I need surgery on my other breast to match?
- How long will the implant last?
- What are the complications you have seen associated with this procedure?