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What is latissimus dorsi flap surgery?

What is latissimus dorsi flap surgery?

Latissimus dorsi flap surgery was one of the most common methods used in breast reconstruction. It is used slightly less often now with increased use of implants and DIEP flap surgery but is still an important option. This is often requested after a mastectomy is carried out as part of treatment for breast cancer. It can be carried out during the mastectomy procedure or afterwards, depending on your individual circumstances and preferences.

This guide aims to tell you all about this type of reconstructive surgery, including what you can expect during the procedure itself, with the aim of helping you to decide if it would be a good choice for you.

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What is the latissimus dorsi flap procedure?

This procedure involves what is known as autologous reconstruction, which means it uses your own tissue as part of the procedure. It is a type of flap reconstruction that makes use of muscle, fat and skin from your upper back, called the latissimus dorsi flap. These are used to rebuild the shape of the breast following a mastectomy. The procedure can be very effective at creating a natural breast shape.

Some tissue flaps can be used alone to shape a breast but this particular flap is normally used alongside implant reconstruction. A breast implant is located behind the muscle in order to add volume to the breast.

This form of perforator flap surgery is named after the latissimus dorsi muscle. This is a triangle-shaped, large back muscle that gives attached fat and tissue the appropriate blood supply. It is the largest muscle in your body, measuring between 20cm and 40cm, which offers lots of potential when it comes to covering large wounds. Its blood supply comes from the thoracodorsal artery.

Latissimus dorsi flap surgery can be used for immediate breast reconstruction at the time of your mastectomy or at a later time. You can start to consider your options by looking at the different procedures available.

This type of breast construction is an intensive operation and you will need to allow time for recovery. You are likely to have a hospital stay of up to a week following the procedure and there is an average recovery period of around two months.

Who is suitable for latissimus dorsi flap surgery?

Latissimus dorsi flap reconstruction surgery is most suited to someone with sufficient back fat to create a usable latissimus flap. It may also be best for women who do not make appropriate candidates for other procedures, such as DIEP flap, TRAM flap or SIEA flap reconstruction from the abdomen. This could be because they do not have enough tissue in their abdomen or because they require another option after a reconstructive surgery failure.

Latissimus dorsi flap reconstruction is a very good choice for women who have small or medium to small breasts. It can also be used at the same time as radiotherapy treatments.

There are several reasons why you may not be a suitable candidate for latissimus dorsi flap reconstruction. These may include:

  • A lack of spare tissue.
  • Your health is not suitable for such intensive surgery.
  • You do not want such large-scale surgery and the creation of additional scars or cuts on your body.

What is the surgery process?

If you are considering latissimus dorsi flap surgery you may want to know what the procedure will actually involve.

Before your breast reconstruction surgery

A latissimus dorsi flap reconstruction may be carried out in two stages. Before the final reconstructive surgery, a tissue expander may be used to gradually make an adequately sized skin pocket to hold an implant.

Before any surgery, you will have to have a pre-operative assessment to ensure that it is safe for you to have the procedure.

During latissimus dorsi flap reconstruction surgery

During your flap surgery, an incision will be made on your back, below your shoulder blade. A latissimus dorsi muscle flap will be created from an oval area of muscle, skin, fat, and blood vessels. This will be slid along a tunnel beneath your skin. The musculocutaneous flap will be moved beneath your arm and into your chest where it can be used to create a breast shape.

As this is a pedicled flap, the relevant blood vessels will still be left attached to your back. This means that they will continue to make use of their original blood supply.

If you are having implant reconstruction, the implant will be inserted and the whole surgical procedure should last between around three and four hours.

After your latissimus flap reconstruction procedure

Immediately after your reconstruction surgery, you will be moved into a recovery room, where your temperature, blood pressure and heart rate will be monitored. If you feel any pain or nausea from the anaesthesia given during your flap procedure, let a member of the team know as medication may help.

After your period of immediate recovery, you will be moved to a bed for your hospital stay. During this time, you will be given all of the information you need about how to care for yourself after your breast reconstruction surgery.

Your body will take a little while to recover from your reconstructive surgery, not least because the flap procedure involves surgery on two sites (your back and your chest). You will need to care for both incision sites and may need help to look after the site on your back where the skin, fat and muscle flap was removed as you may not be able to reach.

You may also have an incision beneath your arm to tend if your doctor decided that you needed an axillary node dissection to remove lymph nodes.

You will need to give yourself sufficient time to recuperate and it is important to take professional advice from your doctor or plastic surgeon to ensure you do not do anything to interfere with your recovery. It is likely to be at least four weeks before you can lift anything heavy, drive or take part in strenuous sports or sexual activity.

You may benefit from some physical therapy under the guidance of a breast cancer specialist in order to ensure that you maintain movement in your shoulder.

Frequently asked questions

Hopefully, this guide has answered many of the questions you may have about latissimus flap breast reconstruction. You should also speak to your doctor about your individual circumstances. You may also want to do more research into the difference between extended and mini latissimus dorsi flap breast reconstruction surgeries.

What is extended latissimus dorsi flap surgery?

This is where the latissimus flap is extended to carry out larger-scale reconstructions. This may be necessary in the case of very large mastectomy scars or for larger sized ladies with smaller breasts. This type of breast reconstruction uses more fat from the back and does not involve the use of breast implants.

What is mini latissimus dorsi flap surgery?

This is an option if you are eligible for some breast conservation and can allow for reconstructed breast creation with the preservation of the existing breast envelope, along with your nipple-areola area. This can lead to more sensitivity in the breast in the future.