LATISSIMUS DORSI flap reconstruction

Your latissimus dorsi muscle is located in your back, just below your shoulder and behind your armpit. It’s the muscle that helps you do twisting movements, such as swinging a racquet or golf club. An oval flap of skin, fat, muscle, and blood vessels from your upper back are used to reconstruct the breast in a latissimus dorsi flap procedure.

This flap is moved under your skin around to your chest to rebuild your breast. The blood vessels (artery and vein) of the flap are left attached to their original blood supply in your back. Because the flap contains a significant amount of muscle, a latissimus dorsi flap is considered a muscle-transfer type of flap. And while the skin on your back usually has a slightly different color and texture than breast skin, latissimus dorsi flap breast reconstruction usually looks very natural.

Because the donor site for the latissimus dorsi flap is closer to the chest than the donor sites for abdominal tissue flaps, and because the blood vessels in the back are usually strong, the latissimus dorsi flap may be a good reconstruction choice for women who are not good candidates for TRAM, DIEP, or SIEA flaps because of diabetes or other circulatory disease, or for women who smoke, or who plan to become pregnant.

The latissimus dorsi flap is a good option for women with small- to medium-size breasts because there’s usually not much fat on this part of the back. If you have larger breasts and your doctor recommends latissimus dorsi flap reconstruction because of your unique situation, you’ll probably need a saline or silicone implant to achieve your desired size.

A latissimus dorsi flap procedure leaves a scar on your back, but most surgeons try to place the incision so the scar is covered by your bra strap. Also, because a latissimus dorsi flap doesn’t involve abdominal surgery like the TRAM, DIEP, and SIEA flaps, the surgery is less involved and your recovery time is usually shorter.

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While the latissimus dorsi flap can offer good results with few complications, it does have some drawbacks:

You may have partial loss of strength or function that makes it hard to lift things and twist. This can affect your ability to perform certain swimming, golf, or tennis strokes, or turn and manipulate objects.

If they have an implant along with a latissimus dorsi flap, some women say the implant feels firmer than the tissue in front of it.

The fat around the latissimus muscle is stiffer than fat that comes from the belly area, so some women say that their latissimus dorsi reconstructed breast feels ``tighter`` than their other breast.

WHAT TO EXPECT

During latissimus dorsi flap reconstruction surgery, an incision is made in your back near your shoulder blade. Then, an oval section of skin, fat, blood vessels, and muscle are slid through a tunnel under the skin under your arm to your chest and formed into a breast shape. The blood vessels are left attached to their original blood supply in your back. If any blood vessels do have to be cut, they are matched to blood vessels in your chest and carefully reattached under a microscope.

If you’re also receiving an implant, the surgeon will insert that as well. A latissimus dorsi flap procedure lasts about 3 or 4 hours.

AFTER SURGERY

For a latissimus dorsi flap, you usually stay in the hospital for about 4 days. After that it can take about 4 weeks to recover from the surgery. Because you’ve had surgery at two sites on your body (your chest and your back), you might feel worse than someone who had mastectomy alone and it will probably take you longer to recover. You’ll have to take care of two incisions: on your breast and your back. You may need to arrange for help to take care of the incision on your back.

RISKS

Like all surgery, SIEA flap surgery has some risks. Many of the risks associated with SIEA flap surgery are the same as the risks for mastectomy. However, there are some risks that are unique to SIEA flap reconstruction.

Tissue breakdown

In very rare instances, the tissue moved from your back to your breast area won’t get enough blood and some of the tissue might die. Doctors call this tissue breakdown necrosis. Some symptoms of tissue necrosis include pain and bleeding, the skin turning dark blue or black, numbness, and sores that ooze a bad-smelling discharge or pus. You also may run a fever or feel sick. If this happens, your surgeon can trim away the dead tissue. This is done in an operating room under general anesthesia. Because the latissimus dorsi flap stays attached to its original blood supply in your back, this type of reconstruction has less risk of tissue breakdown than either type of a free TRAM flap, a DIEP flap, or an SIEA flap.

Lumps in the reconstructed breast

If the blood supply to some of the fat used to rebuild your breast is cut off, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis. These fat necrosis lumps may or may not go away on their own. They also might cause you some discomfort. If the fat necrosis lumps don’t go away on their own, it’s best to have your surgeon remove them. After having mastectomy and reconstruction, it can be a little scary to find another lump in your rebuilt breast. Having them removed can give you greater peace of mind, as well as ease any discomfort you might have.

Muscle weakness

In some cases, you may have some weakness in your back, shoulder, or arm after latissimus dorsi flap breast reconstruction because some of your back muscle has been moved to your chest. You may have partial loss of strength or function that makes it hard to lift things and twist. This can affect your ability to perform certain swimming, golf, or tennis stokes, or turn and manipulate objects. If you have muscle weakness that is problematic, talk to your doctor to find out if there are exercises you can do to help strengthen the area.