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Updated: February 2010

Latissimus Dorsi Flaps After Skin-sparing Mastectomies

pre-operative bilateral mastectomies tissue expander alloerm

This patient presented for bilateral mastectomies, and chose to undergo reconstruction with latissimus dorsi flaps and tissue expanders. She is seen here before and after skin-sparing mastectomies immediately followed by breast reconstruction with latissimus flaps and expanders, which were later exchanged for silicone gel implants.

Lola's Breast Reconstruction Story:


At age 55, “Life Was Good”. My divorce became final, I rekindled my career and was finally ready to move forward toward my new life which included dating. Then, three days before Christmas, my breast surgeon called me and told me the words no woman ever wants to hear – “You have Breast Cancer”.

A four centimeter nodule of DCIS was discovered in my left breast following my annual mammogram. There were no lumps, no symptoms, no warning signs and I led a healthy lifestyle of eating and exercise. Needless to say, I was shocked, but remarkably composed when I responded into the phone, “What needs to happen next”? After more testing and another appointment with my breast surgeon, I had more choices than I was ready to deal with. That’s what felt most overwhelming for me. All these decisions, what should I do? My doctor spent a long time discussing my options; she was empathetic, honest and forthright. It was important to me that we had that kind of rapport; I trusted her. There was SO much to digest and I was especially glad I brought a friend to take notes.

My doctor referred me to a breast reconstruction surgeon with whom I immediately made an appointment. Coincidentally, two people I knew who had already been through breast cancer and reconstruction surgery had also recommended him. I purchased the book, Breast Cancer for Dummies, a wonderful book that helped me understand in laymen terms the type of cancer I had. This journey was to be all about me so I started a loose-leaf binder, where I kept all my test results, records, doctor visits, questions and lists of medications. My mission was to be in control of this cancer and make decisions that would decrease my odds of a recurrence without compromising the quality of my life, my appearance or my sensuality.

The easiest of my choices was a lumpectomy followed by 6 weeks of radiation, but I was surprised to discover just how much of my breast would be gone after surgery. More than what I had originally thought. I feared, “What if they didn’t get all the cancer, or if it came back?” I also worried how I would feel about myself after a lumpectomy. Would one considerably smaller breast impact my comfort level with dating? After all, I no longer had the supporting husband to accept me unconditionally. Another option was either a mastectomy or a bilateral mastectomy with breast reconstruction. I had to figure out which procedure was the best one for me. After weighing my options versus the statistics, there was one thing I was certain of: I NEVER wanted to hear the words, “You have breast cancer” EVER again, so my resolution became crystal clear. I finally knew “what needs to happen” and was at peace with my choice of a bilateral mastectomy with breast reconstruction. It felt right and the sooner the better.

Once I made the decision to move forward with a bilateral mastectomy my reconstruction surgeon explained the different types of mastectomies to me. Another list of options to consider and more notes! He gave me the pros and cons of the most state-of-the-art techniques and based on my needs and my personal desires he recommended a bilateral latissimus flap surgery. He put me in touch with one of his patients who recently underwent the same surgery that I was contemplating. She was candid with me about her experience. She answered all of my blunt and silly questions and she just so happened to have been divorced and dating. I no longer felt alone. We met for coffee and to this day, we are friends bonded by this life experience.

By now, I felt armed, like a Warrior! From the time I was diagnosed until the date of my surgery was six weeks. My surgeons were, “My Dream Team”, and they were wonderful! Both made me feel cared for and explained in detail what to expect. My surgery was eleven hours. When I woke up I had no pain. I was able to walk to the bathroom. I was anxious to see what I looked like in the mirror. I had two beautiful breast mounds that were tissue expanders - not even my final breasts and I was so okay with how I looked. I went home with eight drains, which honestly, was the worst part of my recovery. Although they were uncomfortable, the drains never stopped me from dressing or visiting with friends. I even drove! Family and friends took great care of me and celebrated with me when the last drain finally came out! And that’s when I felt ready to go back to work.

Breast Cancer was truly eye opener. I was especially touched by how many people I least expected offered to help, cook, do laundry and drive me to and from the doctor. At first, it wasn’t easy to say yes, but I let go and found myself surrounded by the most amazing support network. Looking back, I believe this is what helped me the most to heal spiritually! Everyone tells me I have a positive attitude, but I never felt there was another choice. I needed to advocate for ME in order to survive this! Feeling sorry for myself or thinking, “Why me?” was not an option! I learned that I was resilient and that life is a very precious gift!! For me, there were many blessings that rose above Cancer!

Three months after my bilateral mastectomy, I had my exchange surgery. The tissue expanders were replaced with silicone gel implants. Now, my breasts look and feel very natural. I was surprised at how soft and bouncy they are!! The scars on my back are fading and concealed under my bra strap. At only five months after my surgery, I was wearing regular bathing suits, little summer tops, and I even went braless with no sagging! The next phase was nipple areola reconstruction. “WOW,” is all I can say! It’s been one year since my first surgery and tomorrow, I am having my nipples tattooed. What a way to celebrate being cancer-free and the blessings I have experienced. I am now 56 years old and “Life is Better than Ever!!”


Photos and Doctor Commentary

pre-operative bilateral mastectomies tissue expander alloerm

pre-operative bilateral mastectomies tissue expander alloerm Pre-operative markings for bilateral mastectomies and latissimus flaps

Pre-operative markings for bilateral mastectomies and latissimus flaps

Lola was marked pre-operatively for bilateral skin-sparing mastectomies. The back was marked for the bilateral latissimus flaps. An oblique crescent of skin is included with each flap such that a circular skin island can be used to replace the nipple and areola.


 Early post-operative after bilateral mastectomies and tissue expander AlloDerm® breast reconstruction

Post-operative bilateral mastectomies and tissue expander / latissimus flap breast reconstruction

While there are some contour asymmetries after the first stage of her reconstruction, Lola is well on the way.


After bilateral expander implant exchange and nipple areola reconstruction  After bilateral expander implant exchange and nipple areola reconstruction

Post-operative bilateral tissue expander implant exchange with markings for the next stage of reconstruction

This is Lola four months after her second stage surgery, which included bilateral tissue expander and implant exchange. Markings are seen here for bilateral nipple areola reconstruction and breast revision to include upper breast fat injections. The fat injections are intended to provide soft-tissue fill that will soften the appearance along the upper edges of her implants. Nipple reconstruction is planned using a modified skate flap purse-string technique.


Final reconstruction after nipple areola tattoo right 

 Final reconstruction after nipple areola tattoo center Final reconstruction after nipple areola tattoo left

After bilateral fat injection and nipple areola reconstruction

Lola is seen here exactly one year to the day after her mastectomies. With her nipples fully healed, she underwent nipple tattoo to provide a more natural color tone. We look forward to seeing her with her completed breast reconstruction after the tattoos have healed!





Completed bilateral latissimus flap breast reconstruction

This is Lola's completed breast reconstruction. She is seen one and half years after her mastectomies and latissimus flap implant breast reconstruction. Her nipple tattoos have healed providing a natural color.


Fully healed latissimus flap donor scar

The latissimus flap was initially designed such that the final back scar will heal in an oblique orientation. This is the most favorable scar orientation, allowing the scar to fade in the months after surgery.