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Feb 21, 2016 · The extended latissimus dorsi flap is a reliable method for totally autologous breast reconstruction and can be considered a primary choice for breast reconstruction, particularly in women who otherwise are at high risk for a TRAM flap or an implant procedure. Introduction.
After photos were taken 9 mo. after tissue expanders were removed and replaced with 745 ml implants bilaterally, 195 ml grafted fat split between the breasts with bilateral nipple reconstruction and scar revision.
- Overview
- What is latissimus dorsi flap reconstruction?
- What to expect
- Who should have latissimus dorsi flap reconstruction?
- Side effects and recovery
- Other types of reconstruction
After having a breast or breasts removed, many women choose to undergo reconstructive surgery.
While there are several reconstructive options available, latissimus dorsi flap reconstruction is a good option for many women who are not candidates for other reconstructive procedures.
The latissimus dorsi is one of the largest muscles in the body. Situated below the shoulder and behind the armpit, the muscle allows a person to move in a twisting motion, such as when swinging a racket or golf club.
In a latissimus dorsi muscle myocutaneous flap (LDMF) reconstruction, surgeons take a large flap of skin, containing some, fat, muscle and blood vessels from this area of the back.
One of the most reliable flaps used in reconstructive surgery, it is known for its use in chest wall surgery and reconstruction after breast removal. It is particularly effective because of its proximity to the chest and because of the blood vessels that keep blood circulating.
During latissimus dorsi flap reconstruction surgery, the surgeon makes an incision in the back near the shoulder blade and passes the oval section of skin, fat, blood vessels, and muscle through a tunnel under the skin and arm to the chest. Once in place, the mass is sculpted into a breast shape.
The blood vessels remain attached to their original blood supply in the back. If any of these blood vessels are severed during the procedure, the surgeon matches them to blood vessels in the chest and uses a microscope (microsurgery) to reattach them.
In most cases, the surgeon will also place an implant in the breast to achieve the desired shape, size, and projection. The entire surgical procedure lasts between 3 and 4 hours.
It is important for people to follow any instructions that their doctor gives them at the pre-operative appointment. Some instructions may include having blood tests, a chest X-ray, or a test to check the electrical activity of the heart called an electrocardiogram (EKG).
Before surgery, most people will need to stop taking aspirin, blood thinners, anything with vitamin E, and any nonsteroidal anti-inflammatory medications (NSAIDs). Additionally, taking a stool softener will help with constipation that often results after the surgery because of the narcotics used.
Additionally, a woman should prepare for surgery by:
•Stopping smoking. Smoking can add complications to the surgery, and some surgeons will refuse to operate on a smoker. A woman should quit smoking as soon as breast cancer is diagnosed to help eliminate potential risks.
•Preparing the home for recovery. This may include preparing a bed with supports and pillows, moving the bed and other essentials to the ground floor to avoid stairs, and putting things, such as medicines and other important objects within easy reach.
•Preparing for comfort after surgery. This may include getting looser fitting clothes, finding a caregiver, and having sandals available to wear, as these are easier to put on than regular shoes.
Though a good option for some women, latissimus dorsi flap reconstruction is not the only option available.
A latissimus dorsi flap reconstruction does have some advantages, such as being close to the donor site as well as the blood vessels it requires. Perhaps, the ideal candidate for this surgery is a woman who has small or medium-sized breasts, as there is limited fat in the latissimus dorsi flap.
This type of reconstruction is a good option for women who may not be suitable for other types of reconstructive surgery. Some reasons why a woman may not be an ideal candidate for other treatments include:
•previous flaps have failed, so a secondary method is needed
•there is not enough tissue in other parts of the body, particularly the abdomen, to use in the reconstruction
•they do not have access to a qualified plastic surgeon who can perform the microsurgery that latissimus dorsi flaps require
Latissimus dorsi flap reconstruction has risks similar to other reconstruction surgeries. Some of the most common areas of concern are:
•Partial loss of strength or movement that makes it hard to lift things and twist. In cases where both breasts need to be reconstructed, the latissimus dorsi flap is not the best choice as this may result in muscle weakness on both sides of the body.
•Many women need an implant along with a latissimus dorsi flap. Some women feel that the implant feels firmer than the tissue in front it.
•The fat in the latissimus dorsi flap is firmer than other body fat. As a result, the reconstructed breast will feel firmer than the other breast.
Women tend to be moved to a recovery room after surgery, and will probably remain there for some time. During this recovery period, hospital staff members will monitor the woman’s heart rate, blood pressure, and body temperature.
It is not uncommon for women to feel pain or sick from the anesthesia. Medications are available to treat both of these conditions, however.
There are many additional options for breast reconstruction following breast removal or other procedures on the breasts.
Two of the more common reconstruction methods using flaps are:
Deep inferior epigastric artery perforator (DIEP) flap
DIEP is a newer flap technique. A surgeon uses the skin and fatty tissue from the lower abdomen to reconstruct a breast. The muscles are left intact.
The procedure has a slimming effect to the lower abdomen, which some women view as an added benefit. However, it is best for women to follow their doctor’s recommendation for the best method of reconstruction.
Transverse rectus abdominis muscle (TRAM) flap
Mar 3, 2019 · The latissimus dorsi flap, either as pedicled or as microvascular free tissue transfer, is one of the most commonly used flaps in reconstructive surgery, with large vessel diameters and a long reliable pedicle.
Feb 21, 2024 · Reconstruction with the latissimus dorsi myocutaneous flap produces a breast with ptosis and projection while maintaining the natural consistency and feel of normal tissue. This flap...
Aug 8, 2023 · The latissimus dorsi flap (LDF) has gained popularity given its versatile nature and broad applicability in breast reconstruction. Its resurgence has been attributed to its ability to be enhanced using implant or high-volume fat grafting, rendering it a primary option for selected patients.
People also ask
How does latissimus dorsi flap surgery work?
What is a latissimus dorsi muscle myocutaneous flap (ldmf) reconstruction?
Can latissimus dorsi flaps be used for breast reconstruction?
What is the latissimus dorsi flap?
Nov 8, 2016 · In a latissimus flap implant breast reconstruction, an oval flap of skin, fat, muscle and blood vessels from your back is moved under your armpit, around to your chest. The blood vessels are never severed - they remain attached to the original blood supply in your back, so there's no need for microsurgery.
