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What is mini latissimus dorsi flap surgery?

What is mini latissimus dorsi flap surgery?

There could be various personal reasons for seeking information about breast reconstruction surgery. Primarily, it will be a way of making important decisions before undergoing surgery to treat breast cancer. A term you will come across within this research is the latissimus dorsi (LD) breast reconstruction. There are three main types of latissimus dorsi flap surgery: standardextended and mini.

This article will focus on mini latissimus dorsi flap surgery, discussing what this breast reconstruction procedure involves in more detail and weighing up its pros and cons.

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What is mini latissimus dorsi flap surgery?

The mini latissimus dorsi flap procedure is offered to patients who are having a lumpectomy rather than a full mastectomy. This is when the surgeon is able to offer a breast conserving surgery, removing a mass without taking away all the surrounding tissue. The breast envelope and nipple-areola are retained, making it easier to reconstruct your breast seamlessly as part of the tumour removal process.

It is common for breast cancer reconstruction of various types to use tissue from your back. This is where the latissimus dorsi, a muscle that helps you to twist around, is located. During a mini latissimus dorsi flap operation a small section of this muscle is removed, pushed carefully to your chest beneath your armpit, and used to fill the space created where the mass was taken away.

Standard latissimus dorsi flap surgery uses both the muscle and skin from the back to reconstruct the breast, using an implant for volume. The mini version is a partial breast reconstruction that uses only the muscle tissue from the back and much of the original breast tissue to create shape and retain breast volume and appearance.

In the modern era the mini LD flap can be replaced by other flaps from around the breast, notably the LICAP or LTAP flap. These flaps take skin and fat from the underarm area and avoid taking the muscle.

Advantages and disadvantages

There are many good reasons to use the mini latissimus dorsi flap technique, but also some disadvantages you need to keep in mind. Among the advantages is the possibility of natural-looking results and the ability to enjoy a good level of sensation in the breast after recovery, including around the nipple. One of the reasons it is so common and successful is that blood flow to that section of muscle is retained throughout and is reliable.

Mini latissimus dorsi flap surgery has a very high success rate, and recovery is typically less difficult than alternative reconstruction methods. There’s evidence it leads to fewer post-operative complications, and it is safe to undergo radiotherapy afterwards. Breast-conserving surgical treatments generally require radiotherapy as a follow-up.

It’s not surprising, then, that this is a common breast conservation method following cancer surgery—particularly for women with small or medium-sized breasts who don’t need fat replacing in their new breast shape.

However, the main disadvantage is that you will have a surgical site around your latissimus dorsi muscle which will also take a while to heal. As it is doubly invasive, you may need up to a week in hospital and two months of recovery time.

Occasionally, patients who have undergone latissimus dorsi flap surgery report having weakness or restricted movement in that muscle afterwards, and the scar can feel tight when you do certain movements.

This option for breast conservation and reconstruction carries all the usual post-operative risks, including infections and fluid pooling in either site. Incidentally, plastic surgeons often position the incision on your back in such a way that any scarring is covered by bra straps.

Who is it suitable for?

The mini latissimus dorsi muscle technique for restoring your breast to your required shape and level of sensation is not available if you are undergoing a mastectomy, as a more complete reconstruction would be needed.

Keep in mind that, as it affects the latissimus muscles in your back, you can only take this surgical route once. Repeated muscle extractions would be damaging to your health.

It is for this reason that the newer alternatives of LICAP and LTAP flaps are also used and Stephen McCulley is more likely to offer these alternatives. However, the mini LD flap or variations of it may still be offered in selected cases.

What is the surgery process?

Your surgeon will talk you through all the options and the possibility of having breast-conserving surgery. You may be offered the mini latissimus dorsi flap procedure if the mass to be removed is of a suitable size.

During your surgery, an incision is made and a small section of muscle is harvested from your back, without any skin layers. This ‘flap’ is then moved in a channel under your skin and placed in your chest to rebuild where the tumour was removed.

The whole operation will last between three and four hours. You will probably remain in hospital for one to two days after the surgery, and the first 48 hours will involve remaining in bed to support initial healing.

You will be provided with all the support and information required to know when to start walking, how much physical activity to do and other post-operative care needs following mini latissimus dorsi flap surgery.

Frequently asked questions

What is extended latissimus dorsi flap surgery?

This is when more than just the latissimus muscle is involved. The surgeon would also take skin and fat from the same area, and use this larger amount of tissue to add volume to the breast without reliance on an implant.

How is a latissimus dorsi reconstruction different to DIEP flap surgery?

Both LD breast reconstruction and DIEP (Deep Inferior Epigastric Perforator) flap surgery benefit from the fact that your own tissue is the best material to use in breast reconstruction. It provides the best possible chance of a healthy and successful result. The difference is that DIEP surgery uses the abdomen as the donor site, with only soft tissue (skin and fat) moved to your chest to shape and support your breast.

How is latissimus dorsi flap surgery different to TRAM flap surgery?

There is another option similar to DIEP surgery and this is a transverse rectus abdominis, or TRAM, flap procedure. Like the mini latissimus dorsi option, it uses muscle in the reconstructive process. However, like DIEP surgery, with TRAM the muscle comes from the abdomen.

Understanding the differences between LD, DIEP and TRAM flap options will be an important part of your discussions with your breast cancer surgeon. Our team are available and always ready to talk you through your options and answer any questions you may have about mini latissimus dorsi flap surgery or alternative breast reconstruction procedures.