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Post-mastectomy reconstruction can take many approaches. Patients can opt for implant reconstruction or natural tissue reconstruction, of which there are multiple available techniques. The latissimus dorsi (LD) flap approach to breast reconstruction utilizes a natural tissue flap from the back that is typically combined with an implant. This technique has been utilized since the 1970s with improvements made over the years such that the current approach can reliably provide a natural appearing breast reconstruction. Dr. Tamburrino has extensive experience with LD flap breast reconstruction. During your initial consultation with our team, we can evaluate your condition, discuss your goals, and determine which approach to breast reconstruction best fits your needs. To arrange a consultation, contact us.

Latissimus Dorsi Flap Breast Reconstruction

The LD flap is typically raised from the upper mid-back using horizontal or oblique incisions in skin. Once these incisions have been made, the LD flap is elevated and brought around to the chest wall. The thoracodorsal artery is the main source of blood supply for the LD flap, and the primary vessels are left attached. The thoracodorsal nerve, which innervates the LD muscle can be divided in order to minimize muscle movement once the breast reconstruction has healed. Although the LD muscle is removed and transferred from the back, there are generally minimal if any significant physical limitations after this procedure.

In some patients, the LD flap can provide sufficient tissue for a small breast reconstruction without an underlying implant. This is particularly true in the case of a man undergoing mastectomy to treat breast cancer. In most women undergoing LD flap reconstruction, a breast implant or tissue expander is placed under the flap in order to provide volume.

Breast reconstruction with an LD flap can be done immediately after mastectomy or as a delayed procedure after the patient has healed from the mastectomy. The flap is a valuable source of soft tissue that may allow for a more natural looking and natural feeling breast than would be possible through implants alone.  This flap is also very useful to salvage a previously failed breast reconstruction or to correct contour deformities secondary to prior lumpectomy.

Risks and Benefits

Breast reconstruction with an LD flap is a proven technique that has been in use for decades. Patients considering this procedure who are competitive athletes should be aware that they might develop some weakening of shoulder extension and adduction. Generally, activities of daily living are not adversely affected by this surgery.

The primary benefit of LD flap breast reconstruction is that it allows for a more natural reconstruction as compared to the use of an implant alone. Because the LD flap procedure can be utilized as a natural tissue approach to breast reconstruction or in combination with implant reconstruction, a wide range of patients can have their needs met through this approach.  This includes patients who have deformities related to lumpectomy and radiation as well as those who may have had problems with other types of breast reconstruction procedures.

Candidates

Ideal candidates for LD flap reconstruction are women who do not have sufficient tissue from alternative flap donor sites but still desire a reconstruction with natural tissue. Also, women with damaged or insufficient tissue on the chest to cover an expander or implant may require an LD flap as part of their breast reconstruction. This is particularly true for those who have had prior chest wall radiation or have failed other methods of breast reconstruction. For women who have a breast deformity related to prior lumpectomy, an LD flap can be utilized to improve the breast contour. For men undergoing mastectomy, the LD flap alone can restore chest contour. Individuals who have had previous surgery on the chest wall, such as a thoracotomy, or participate in highly rigorous sports that place great stress on the back muscles, such as rock climbing, may not be ideal candidates for this procedure.

Because of the muscle's proximity to the chest, latissimus dorsi flap for breast reconstruction after mastectomy is a popular technique. In addition, the transferred tissue can remain attached to its natural blood supply, making the procedure less complicated than other flap procedures. 

The latissimus dorsi flap can be used for breast reconstruction with or without a saline or silicone breast implant. If an implant is going to be used, a temporary tissue expander is often placed under the transferred tissue. After the device is in place, fluid is periodically injected into the expander. This allows the muscle and tissue to stretch and accommodate a permanent implant while also producing a more natural appearance.