Latissimus Dorsi Flap
The latissimus dorsi (LD) flap is a standard method for breast reconstruction that was first utilized in the 1970’s. The latissimus dorsi flap is most commonly combined with a tissue expander or implant, to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone. Occasionally, for a thin patient with a small breast volume, the latissimus dorsi flap can be used alone as the primary reconstruction without the need for an implant.
Latissimus Dorsi Flap Reconstruction
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Many surgeons will resort to the use of an latissimus dorsi flap as a backup option if a patient has wound healing problems or soft tissue failure in the setting of an implant. The latissimus dorsi flap can also be used as a salvage procedure for patients who have had previous radiation, and are not candidates for other autogeneous procedures. A large open wound on the chest wall is also an indication for an LD flap in patients that need chest wall reconstruction alone, without creation of a breast shape.
The thoracodorsal artery is the primary source of blood supply to the latissimus dorsi flap. At the time of breast reconstruction, the muscle flap, with or without attached skin, is elevated off of the back and brought around to the front of the chest wall. The main vessels remain attached to the body to ensure proper blood supply to the flap. The LD flap provides soft tissue to allow complete coverage of an underlying implant.
The length of surgery for latissimus dorsi flap breast reconstruction is typically two to three hours, and requires one to three post-operative days in the hospital. The initial recovery time is two to three weeks. Depending on the patient, the scar from the LD flap donor site on the back can be placed diagonally or horizontally. A horizontal scar can usually be concealed under a bra strap. Patients generally have no major long-term physical limitations from taking the latissimus muscle. Activities of daily living and most exercise can be resumed without significant loss of proficiency.
Secondary procedures after an latissimus dorsi flap reconstruction can be done in about three months. These may include expander implant exchange, adjustment procedures to improve breast symmetry, and nipple areola reconstruction. As with any type of reconstruction, if chemotherapy is needed, any additional surgery must await completion of treatment. Such additional procedures are typically done as outpatient surgery with a rapid recovery.
You are an ideal candidate for latissimus dorsi flap reconstruction if you:
- are thin with a small breast volume
- have excess tissue laterally and upward across the midback
- have had previous radiation and are having an implant reconstruction
- are not a candidate for other autogeneous procedures
- are having a partial breast reconstruction in order to correct a lumpectomy defect
- have thin skin that requires extra coverage for an implant
- desire a more natural appearance than that of an implant alone
- are having immediate or delayed reconstruction
You are not an ideal candidate for LD flap reconstruction if you:
- do not wish to have additional scarring to a part of the body other than the breasts
- have had previous chest-wall surgery such as a thoracotomy
- participate in extreme competitive sports such as mountain climbing, skiing, and swimming
Please go to our Personal Stories section to see before and after photos.