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Latissimus Dorsi Flap for Breast Reconstruction Surgery

Plastic Surgery to Restore Breast Symmetry

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Updated April 27, 2012

The latissimus dorsi breast reconstruction method is a tissue flap procedure that takes its name from the latissimus dorsi muscle in your upper back. Learning about the latissimus dorsi breast construction method, its advantages and disadvantages, and what to expect can help you better determine if this procedure is right for you.

What is Latissimus Dorsi Tissue Flap Breast Reconstruction?

The latissimus dorsi is a tissue flap procedure that uses muscle and skin from your upper back to create a new breast mound after a mastectomy. An ellipse of skin and your latissimus dorsi muscle will be tunneled from your upper back to your mastectomy area to create your reconstructed breast. Your reconstructed breast will not look and feel exactly the same as your natural breast, and you will need additional surgery to create a nipple and areola, if your own cannot be saved.

Advantages of the Latissimus Dorsi

A tissue flap breast reconstruction such as latissimus dorsi should last you for life. It may require a small breast implant, in addition to your own tissue. The transplanted skin will be a close color match for your breast skin. Your reconstructed breast will feel warm and somewhat flexible.

Disadvantages of the Latissimus Dorsi

The Latissimus Dorsi method is considered a major procedure, and you will be in surgery longer than a patient who is getting breast implants only. Healing will also take longer with a tissue flap procedure, since you will have two surgical sites and two scars. Afterward, many women may experience weakness in the arm and back muscles and need physical therapy. There is a risk of developing infection at the surgical sites and experiencing trouble healing. The risk of failure for the latissimus dorsi is less than 1%. A very experienced plastic surgeon can try to prevent complications and flap failure.

You're Not a Candidate If...

Blood vessels will be moved and reconnected during a tissue flap procedure, so if you have any conditions that affect your circulation, you would not have successful tissue transplantation. Women who have any of these problems are not candidates for tissue flap reconstruction:
  • diabetes
  • vascular disease
  • connective tissue
If you are overweight or obese, have large breasts, or smoke, the latissimus dorsi flap is not for you. This procedure works best for women who have average amounts of body fat and have small- to medium-size breasts.

Breast Reconstruction Now or Later?

Breast reconstruction can be done at the same time as mastectomy or after treatment. If you need radiation therapy to the underarm area or chest, however, it is worth waiting; having the procedure done before treatment is complete severely limits a radiation therapist's ability to treat you properly.

If you are thinking about reconstruction, it's a good idea to talk with your plastic surgeon before having a mastectomy. This gives you the chance to have measurements and pictures taken of your natural breasts, so your reconstructed breast can be recreated as accurately as possible. Your plastic surgeon will have a range of options to offer you, and can help save skin and prevent unnecessary scars, if you consult with him beforehand.

What to Expect During a Latissimus Dorsi Breast Reconstruction

You will not be awake during your mastectomy or reconstruction, so you will have intravenous sedation or general anesthesia. Talk to your surgeon and the anesthesiologist about which will work best for you, and be sure he or she is informed of all medications and supplements you are taking. If you are having a mastectomy and reconstruction at the same time (immediate reconstruction), your general surgeon will first remove your breast, sparing as much skin as will be safe to keep.

Getting Ready for Latissimus Dorsi Breast Reconstruction

Latissimus Dorsi Breast Reconstruction
Illustration © National Cancer Institute
Your plastic surgeon will use a skin marker to carefully plan for the incision that will create your skin flap. A pointed ellipse will be drawn on your back, over your latissimus dorsi muscle. This ellipse will become the skin flap that closes the incision for your reconstructed breast. When the incision for the flap is shut, it will be about 10 to 15 cm in length and follow the line of one of your ribs.

Moving Muscle and Skin

Latissimus Dorsi Breast Reconstruction
Illustration © National Cancer Institute
Your plastic surgeon will make an incision on the skin markings, raising the skin and muscle flap. A tunnel will be created under your skin so that the flap can be relocated. This tissue flap will go through the tunnel to the front of your chest, keeping its blood supply intact. This ensures that the skin and muscle will continue to live in their new location. The skin will be positioned so that it fills in the skin that was lost during your mastectomy. If you need an implant, the muscle will be draped over it to create the new breast mound.

Closing Incisions and Starting Recovery

Latissimus Dorsi Breast Reconstruction
Illustration © National Cancer Institute
Your back incision will be closed, and a surgical drain may be placed in it to help remove excess fluid. On your chest, the skin flap will be carefully joined to the mastectomy incision. If needed, scar tissue from your mastectomy may be removed in order to create a smoother skin texture at the new incision. Some patients may need a surgical drain in the reconstructed breast to help prevent fluid build-up and promote healing.

Recovering from Latissimus Dorsi Breast Reconstruction

You may need to stay in the hospital for three or four days as you begin healing from breast reconstructive surgery. If you have surgical drains, you will learn how to empty those and keep records of the fluid volume. Report pain if you have any, so that it can be treated. Don't go right back to work – plan on taking it easy for three to six weeks for recovery. Be sure to have someone around to help drive you and do any lifting. Be sure to go for your follow-up appointments so your surgeon can keep an eye on your incisions and dressings and remove your drains.

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Sources:

American Cancer Society. Breast Reconstruction After Mastectomy. Types of Breast Reconstruction. Revised: 09/06/2007.

National Cancer Institute. Surgery Choices for Women with Early-Stage Breast Cancer. Step 3. Find out about your breast cancer surgery choices. Breast Reconstruction Surgery. Posted: 10/22/2004.

Discuss Breast Reconstruction in the Forum

There are many types of breast reconstruction - implants, TRAM, Latissimus Dorsi, SGAP, DIEP Flap. What procedure did you have? Would you recommend it to anyone else? What went right or wrong with your reconstruction?
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