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Latissimus Dorsi Flap

Also known as Autologous Breast Reconstruction.

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Autologous breast reconstruction refers to the creation of a new breast mound from the patient’s own tissue. This involves replacing breast tissue lost during a mastectomy with the patient’s own muscle, skin and fat from another part of the body. In the Latissimus Dorsi Flap Procedure, the donor site is the upper back on the same side as the mastectomy. The latissimus dorsi muscle is considered expendable because no significant loss of adduction or rotation of the arm occurs if the other muscles of the shoulder girdle are intact. It is the largest and strongest muscle of the back.

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Breast reconstruction using a flap may require a small breast implant in addition to your own tissue to equal the volume of the remaining breast. The transplanted skin will be a close color match for your breast skin and the breast will feel natural, warm and somewhat flexible.

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The goal of breast reconstruction is to match the affected breast as closely as possible in shape and size to the natural breast. In the case of bilateral reconstruction (both breasts), this procedure allows for greater flexibility in size, selection and symmetry. Dr. Van Laeken will help you determine if this is an appropriate procedure for you. She will review the surgical techniques and share with you, before and after photos at the time of your consultation.

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This procedure can be done either at the time of the mastectomy (immediate reconstruction) or later (delayed reconstruction).

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Breast reconstruction makes many women feel better about their appearance, however, it is important, to be realistic about the expected outcomes. A reconstructed breast won’t look exactly like your original breast nor will the sensation be similar.

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This reconstructive approach requires 2 operative procedures and can take 6 months to one year to complete.

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Postmastectomy

View showing back scar

Latissimus dorsi flap and nipple/areola reconstruction

Who is a candidate?

  • Patients who have had a mastectomy

  • Patients seeking autologous reconstruction who have had multiple abdominal surgeries or who have inadequate abdominal tissue and therefore are not candidates for a tram procedure.

  • Patients requiring radiation

  • Nonsmokers

  • Patients who require mobility aids such as crutches or wheelchairs who relying on their complete shoulder function are not considered candidates for this procedure as it may create an unacceptable disability.

  • Patients who have had extensive axillary dissection may not be candidates. Screening is based on an individual basis.

  • Women who have any of the following conditions may not be candidates for tissue flap reconstruction:

  • Diabetes

  • Vascular Disease

  • Connective Tissue Disorder

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This procedure works best for women who have average amounts of body fat and have small- to medium-size breasts.

Preparation for surgery

It is very important that Dr. Van Laeken is aware of the state of your general health prior to surgery. Please let her know of any allergies you have, medications, herbal supplements, or vitamins you are taking as well as the reasons for taking them. It is also important that you inform Dr. Van Laeken if you have a tendency for keloid scarring (thick, wide, or raised scars).

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If you are a smoker you must quit smoking before your surgery for at least 14 days. Smoking can interfere with the blood flow to the skin, and will inhibit the healing of the incisions.

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Patients should prepare for a 1–3 day hospital stay, organize home care for 2-3 weeks, and purchase a supportive surgical bra. 

Procedure

The operation is generally conducted as an overnight stay procedure, undertaken under general anesthesia and requiring approximately 2 -3 hours for completion.

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An incision is made, most commonly along the natural lines of the back – either tracing the perimeter of the scapula (peri-scapular) or situated within the groove beneath the arm (infra-scapular). Through this opening, the latissimus dorsi muscle – a broad muscle spanning the back – is meticulously detached and transposed. This muscle is then repositioned to create a desired contour and projection to the breast area. Following muscle transposition with the overlaying skin and fat, a breast is created.

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Sutures will be used to achieve a cosmetically pleasing and functionally secure closure. A sterile dressing will be applied, and remain in place for 7 - 10 days.

Recovery

There will be considerable swelling and bruising around the operated area for the initial few days following surgery. This is entirely normal and should gradually diminish within 2 to 6 weeks.  Hospital stay is normally 1 - 2 days.

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Dr. Van Laeken recommends that upon your return home from the surgical facility, you prioritize rest. For the first 24 hours, get into bed and limit activity to walking to the bathroom and back. Avoid raising your arms above your head during this period. Slowly increase your activity levels as you feel comfortable. Absolutely no pulling, pushing, or lifting should be undertaken for 5 to 7 days post-surgery.

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You will be provided with a prescription for pain medication; please take it as directed. If your implant was placed beneath the muscle flap, you might experience a slightly heightened level of discomfort. Applying ice packs or frozen peas to your upper back may assist in alleviating some of that discomfort.

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Following the surgery, your breasts will likely feel swollen and the dressing will feel snug. This is perfectly typical. It is absolutely crucial to leave the dressing undisturbed – it provides vital compression and helps prevent bleeding.

Do not shower until the dressing has been removed. You may take a bath, but please ensure the dressing remains completely dry.

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The second visit will be approximately 10 - 14 days after the surgery to remove the sutures. During this visit, you will be instructed on how and when to begin breast massage. This massage is essential to manage the formation of scar tissue around the implant. You can likely begin wearing an underwire bra around 4 weeks post-op.

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Most patients typically return to work within 14 - 21 days following surgery, depending on the nature of their employment. If your work involves strenuous lifting, pushing, or pulling, you might be advised to take a longer period of time off. Dr. Van Laeken will be able to provide you with specific guidance regarding your return to work schedule. The final, noticeable aesthetic results of the surgery are usually apparent approximately 6 weeks post-surgery.

Potential Complications

There are risks associated with any type of surgery. Although the incidence of complications is rare, Dr. Van Laeken feels that all patients should be informed of the potential complications prior to proceeding with surgery. Scarring is inevitable with any surgical procedure, and the scar from a Latissimus Dorsi Flap can be prominent. While massage can help manage the scar, it may not completely eliminate its appearance.

Anesthetic Issues

Adverse reactions to local or regional anesthesia, ranging from mild discomfort and itching to more severe complications such as allergic reactions, nerve damage, or hypotension.

Asymmetry

Symmetry is not always achieved.

DVT / PE

Abbreviations of Deep Vein Thrombosis and Pulmonary Embolism. DVT is a blood clot in a deep vein, typically in the leg. PE is a potentially life-threatening condition where a DVT breaks loose and travels to the lungs, obstructing blood flow.

Haematoma

Blood can gather under the skin and cause a blood clot. If this does occur, Dr. Van Laeken can drain the area. Indications of a haematoma are a firm, painful lump that causes colour change in the skin. This rarely occurs after 48 hours post operatively.

Infection

Signs of infection are localized heat, redness, fever, and pain. Dr. Van Laeken can prescribe antibiotics to treat the infection. Occasionally the area will need to be drained.

Keloid Scarring

Keloid scars are thick, wide, or raised scars.

Necrosis

Tissue loss that can occur when blood supply to the skin and tissue is compromised.

Contact us

To find out more or to book your consultation.

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