Breast reconstruction with a combination of implant and flap
Combination methods are appropriate in a number of circumstances. If implant reconstruction is preferred, but the tissues on the chest are insufficient to provide healthy cover, a tissue transfer can be employed to house and protect the device. Also, some patients may seek somewhat greater fullness than a particular flap can provide on its own, leading the surgeon to augment the tissue transfer with a small implant. Finally, combination methods are of great use in bilateral reconstructions when tissue alone cannot provide the breast size desired on two sides.
This type of breast reconstruction requires the use of a smaller tissue expander/implant along with your own tissue because of the limited volume of your back tissue.
LATISSIMUS DORSI FLAP
This flap borrows muscle and skin from the upper back. Although this method provides much of the needed skin, there isn’t enough tissue volume to form the breast mound by itself, so either a tissue expander or implant can be used to stretch the transferred muscle and skin. At a later stage the tissue expander is replaced with a permanent implant.
This procedure is most commonly performed if you’ve had a mastectomy on one of your breasts followed by radiation and don’t meet the criteria for a TRAM or DIEP flap. This procedure is not recommended if you perform a lot of repetitive or strenuous overhead activities with your arms.