Comparing oncoplastic breast surgeries and the LD flap
Among the list of considerations you will face as part of your breast cancer treatment plan will be which type of reconstructive surgery you should opt for if this is something you are able and willing to endure.
Today there are a number of breast reconstruction surgeries, some of which use a patient’s own tissue to rebuild the shape and size of the affected breast(s). Two such procedures are the LD flap and the oncoplastic method.
In this article, we will compare oncoplastic methods to the LD flap and discuss some of the factors to consider if you have been recommended one of these procedures as part of your breast cancer treatment. Click on one of the links below to jump to that section:
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Oncoplastic breast-conserving surgery is the combination of oncology and plastic surgery. It encompasses a range of procedures, and as a practice involves combining cancer removal and immediate breast reconstruction in a single surgery. Types of oncoplastic breast surgery include the TDAP flap, LICAP flap and LTAP flap.
These surgeries are performed by cutting out a small section of tissue from the side of the torso beneath the armpit. This tissue remains connected to its blood supply and is tunnelled under the skin from the back to the chest. Alternatively, the therapeutic mammoplasty combines a lumpectomy and breast reduction to create a smaller, more uplifted shape. The advantages of these surgeries are that they conserve as much of the patient’s natural breast tissue as possible and are less invasive than traditional reconstructive techniques.
The latissimus dorsi (LD) flap is a breast reconstruction surgery performed after a mastectomy. It is an autologous reconstruction method, meaning it uses the patient’s own tissue. Fat and skin are used alongside the latissimus dorsi muscle (found in the upper back) to rebuild the breast shape. In many cases, an implant may also be inserted behind the muscle to add volume. Alternatively, a mini LD flap may be offered to patients who have undergone a lumpectomy instead of a full mastectomy.
Like oncoplastic surgery, the LD flap reconstruction is capable of achieving very natural-looking results and good levels of sensation post-recovery, especially the mini LD flap. The use of the LD flap is less common with use of LTAP and LICAP flaps from lateral chest wall. These do not disrupt the muscle.
Oncoplastic methods are only available for cancer patients who are eligible for treatment through breast conservation surgery. Techniques such as the TDAP flap are more suitable for women with small to medium-sized breasts and enough healthy tissue to be used in the reconstruction. Women with large or very saggy (ptotic) breasts would be more suitable for the therapeutic mammoplasty if they are willing to undergo a breast reduction.
In cases where cancer is more advanced or takes up more than 25% of a patient’s breast, a full mastectomy followed by an LD flap reconstruction may be more suitable. The LD flap is often chosen when the abdomen (DIEP flap) or thigh (TUG or PAP flaps) are not available. An LD flap can be used if a patient has sufficient skin and fat on their back to be used to rebuild the breast. Patients who are underweight would not be recommended an LD flap and would be more suited to an implant reconstruction.
A doctor may also recommend a latissimus dorsi flap reconstruction to a breast cancer patient who does not want to undergo a DIEP flap or TRAM flap procedure.
The recovery process for oncoplastic breast surgeries is relatively quick. Most patients return to their daily activities within a few weeks, though some may need at least six weeks before they can return to work.
On the other hand, the recovery process for the LD flap surgery is lengthy and intensive. This is because the surgery uses muscle as well as skin and fat. There will also be two incision sites to care for: the back and the chest. Both sites will need to be tended to for some time after the surgery, and you may require assistance if the incisions are difficult to reach. LD flap patients are usually discharged from the hospital after two to four days. They can usually return to work and resume normal activities within six to eight weeks.
After either procedure, a patient may feel sore and swollen or experience some bruising on the breast. Throughout recovery, it is important to take care of your body. Follow a healthy diet and get plenty of rest. Your surgeon will recommend that you wear comfortable sports bras and loose-fitting clothing. Strenuous physical activities and heavy lifting should be avoided. You should only start to engage in proper exercise under your doctor’s guidance.
Oncoplastic surgeries are increasingly being recommended to patients who have historically had bad aesthetic outcomes after lumpectomies, which often result in deformities or asymmetry of the breasts. The oncoplastic method, by comparison, offers a more natural appearance and often provides a reduction or lift to create a new breast shape or size.
Additionally, there may be a lack of sensation in the reconstructed breast(s) and nipple(s) immediately after oncoplastic surgery but this usually returns. This is not the case with the LD flap, particularly when implants are used.
Scarring is kept to a minimum with oncoplastic methods and is usually contained to the bra line. Scarring is much more extensive with an LD flap procedure because there will be more than one incision site.
Both approaches are effective methods for breast reconstruction as part of cancer treatments. However, oncoplastic techniques have been shown to offer high levels of long-term patient satisfaction. In a study comparing the TDAP flap and LD flap, no significant differences were found in relation to cosmetic outcomes or post-operative complications, but patients did report better function in the shoulder after a TDAP flap.
Frequently asked questions
What factors can affect the choice of breast reconstruction method?
The choice of breast reconstruction method depends on various factors, including patient age, the size and shape of the breast, the location of the tumour, cancer treatments such as radiation and chemotherapy, and the availability of suitable tissue to rebuild breast volume. Other factors include personal preference and additional medical conditions such as obesity or diabetes.
Additionally, with an oncoplastic technique like the LTAP flap, the surgeon will not be able to guarantee this surgery can be performed until the relevant artery has been identified with a Doppler during pre-surgery planning.
If you’d like more information about breast reconstruction surgeries or would like to discuss your options, get in touch with the Stephen McCulley team.