Procedure In Brief

The back is commonly used to reconstruct the breast using three different methods. Stephen McCulley often uses the back as a skin source in order to perform a breast reconstruction.

Stephen commonly finds this gives better results than the stand-alone implant reconstruction.

Standard Latissimus Dorsi Flap

This is the most common method in which muscle and skin from the back is placed into the breast. An implant is then placed behind the muscle to give volume.

Advantages

This method can result in an excellent breast shape (more natural than compared to implant reconstruction) and can be used in both immediate and delayed reconstruction.
This is a very reliable form of surgery that only carries a 1% risk of the reconstruction failing.
The operation can be safely carried out in conjunction with radiotherapy treatment.
Overall, this is one of the most common forms of reconstruction and regarded by many as the standard procedure to use when opting for breast reconstruction.

Disadvantages

This is an intensive operation that will require up to a week’s stay in hospital and then up to 2 months in recovery.
Although uncommon, some patients may experience weakness and restriction in their shoulder following surgery.
The scar on the patient’s back can feel tight, especially with certain movements.
There is a 2% risk of the implant becoming infected and therefore needing to be treated. There is also the chance of fluid collecting in the back (seroma) which would need to be removed.
As with any procedure involving implants, there are certain risks associated with having them. See implant problems for further information.

Extended Latissimus Dorsi Flap

This type of procedure avoids the use of an implant as the muscle that is removed from the back (along with skin) has a lot of fat on it, which is then used to give volume in the breast.

Advantages

This method can result in an excellent breast shape (more natural than compared to implant reconstruction) and can be used in both immediate and delayed reconstruction.
This surgery can withstand radiotherapy well.
The operation is very reliable with only 1% chance of failure.
If any infection does occur it can easily be treated as there is no implant.

Disadvantages

This method is not suitable for everyone. Stephen McCulley will be able to assess its suitability for you during your consultation.
This is an intensive operation that will require up to a week’s stay in hospital and then up to 2 months in recovery.
The back tends to have more problems healing and will leave a hollow in the back, but should not cause any long term problems.
It can be difficult to judge the size of the reconstructed breast as it tends to shrink around 30% in volume over the first 12 months.

Mini Latissimus Dorsi Flap

This method is used for when only part of the breast has been removed (as with breast conserving surgery) and therefore a part of the muscle is removed from the back (usually no skin is removed) and placed into the breast to fill in the hole. This procedure will not be used with a mastectomy.

Advantages

This method can result in an excellent breast shape (more natural than compared to implant reconstruction) and can be used in both immediate and delayed reconstruction.
The operation is very reliable.
As much of the original breast remains intact there is good sensation in the overall breast.

Disadvantages

It’s important for the patient to consider whether a mastectomy might be planned for the future, as this procedure will use up one of the major reconstructive tools (muscle from the back) and could therefore not be used at a later date.
Radiotherapy will still be required (as with most breast conserving surgery treatment).
The back tends to have more problems healing and will leave a hollow in the back, but should not cause any long term problems.

Surgical Recovery & Final Outcome

Length of stay in hospital – usually 6 days.
Length of surgery – usually between 3-4 hours.
Time restricted to bed – 2 days, in which a bladder catheter will need to be fitted.
Time to walking – patients should be able to walk after 4 days, and walk without any discomfort after 10 days.
Time to exercise – patients should be able to exercise after 4 weeks of recovery.
Time to full recovery – patients should feel fully recovered and be able to return to work by 2-3 months.
Dressings – patients will wear dressings on the breast and back for 2 weeks.
Bras & clothing – patients are advised to wear a pressure garment for 4 weeks.
There is around a 5% risk of experiencing problems with the back – stiffness in the shoulder, fluid collection and possibly infection around the implant following surgery.
There is a 3% chance of experiencing reconstruction problems – infection around the implant, part or total failure of the reconstruction succeeding.
There are moderate risk of having long term problems – implant firmness and poor symmetry compared to the other breast.