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Updated: September 2009

Latissimus Flaps and Implants After Skin-sparing Mastectomies

Pre-operative bilateral mastectomies and latissimus flaps
completed bilateral mastectomies
Before
After

This patient required bilateral mastectomies and elected to undergo latissimus flap and implant breast reconstruction. She is shown before and after bilateral skin-sparing mastectomies and reconstruction utilizing latissimus flaps with tissue expanders which were exchanged for implants at a later stage.

Laura's Breast Reconstruction Story:

 

Last summer, my mother took my 7-year-old daughter to see an American Girl movie. When they came back to my house, my mother told me that she had to talk to me privately. Naturally I became nervous, but was still shocked when she told me that her doctor had called her a few hours earlier to tell her that she had breast cancer. I couldn’t believe that she sat through the movie with my daughter not having told anyone her news. I became very upset, as my mother’s own mother died of breast cancer twenty years earlier. My mother told me that her doctor assured her that she had an excellent chance of survival. She immediately had a lumpectomy and radiation and is healthy today.

Little did I know that my mother’s diagnosis would help to save my life. Over the past few years, I have had several breast biopsies. Luckily, they all turned out to be benign. I felt that every time I went for a mammogram and sonogram, I had to have a biopsy. It was exhausting and unnerving. A few months after my mother’s diagnosis, my mammogram showed a calcification. The radiologist told me that I could leave it alone because there was only a 2 percent chance that it was anything to worry about. I was tempted to do just that given my history of benign growths, but given my mother’s recent diagnosis, I decided to pursue a breast biopsy. A few months later, after scheduling and rescheduling, I finally had the biopsy.

Since all my previous biopsies had amounted to nothing, no one in my family took this one too seriously. When the radiologist called the next day, I knew that was not a good sign. She spoke to my husband and told him that I had a carcinoma and that I "would be very busy for the next few months". My first reaction was that I know a carcinoma means cancer, but she would have said “cancer” if it was. Anyway, with two small children and a full time job, I was too busy to have cancer. The next day, my breast surgeon called me at work (I’m a high school teacher) and said “you have breast cancer”. Well, now there was no denying it. Ten minutes after we hung up, I had to go teach a class. Forty-two minutes later, after the bell rang, I thought “oh God, I have cancer”. It seemed crazy. My grandmother was diagnosed at 70, my mother was also diagnosed at 70, but I was only 43. Thank goodness I didn’t count on there being only a 2 percent chance that those calcification were anything. Someone has to be in that 2 percent.

When I went to speak to my breast surgeon about my options, I had a long list of questions about treatment, and the very last question was about having a mastectomy. Since I was diagnosed with DCIS, I felt silly even asking, and assumed when I did ask she would laugh and tell me that was a pretty radical option. Imagine my surprise when we sat down and the first option she presented was bilateral mastectomy. At first I was put off by the idea, but the more we spoke, the more I realized that this was my best option, both for my survival and for my sanity. I didn’t want to worry every time I felt something in my breast, and God forbid I felt it too late. My breast surgeon gave me the name of a plastic surgeon and his website. I started to do some research all over the internet, and I was pretty shaken up when I saw the pictures of the mastectomies. To me, even the best outcomes looked “Frankensteinish”. I’m not terribly vain, but I have to admit, the scarring upset me. I was obviously still going through with the surgery, but I was disappointed and weepy about the inevitable outcome.

The night before I met with the plastic surgeon, I did some more research. At this point, I was thinking about the DIEP flap surgery. I figured that it would slim down my waste as an added benefit. When I sat down at the computer that night, I decided to read about the recovery, and after a few minutes I began to cry. It was more than I thought I could handle. Not standing up after surgery and being out of work for two months was too much for me. Now I wasn’t sure what I wanted, but I was pretty sure I didn’t want implants and expanders.

I went into the plastic surgeon for my consultation and we discussed all the options. Each of the options seemed less than perfect to me. I felt that some procedures would leave me too scarred and others would leave me with a horribly painful recovery. Having two small children, I felt that I needed to have a quicker, more tolerable recovery. The plastic surgeon was very kind and extremely confidence-inspiring. After extensive discussion, the surgeon told me about another option. He showed me a picture of post-mastectomy breasts with no scars. It looked like magic. He said that he would take skin, tissue and muscle from my back to put over my implants, thus making the end result scar-free breasts that looked and felt very natural. Of course, there would be scars on my back, but the pictures 6 months after surgery showed a woman whose scars were nearly faded. I decided that this was the surgery for me. I thought that I could live with the implants, given the other benefits of this surgery. I left the plastic surgeon’s office feeling completely relieved and that I was in great hands. I wondered why this option, the latissimus flap surgery, was not better represented online. I think that if I had seen it earlier, I would have had less trepidation about the whole idea of mastectomy.

Although I was relieved to have a great option, I still had concerns. My major concern was that I wouldn’t be able to lie on my back or my front after the surgery. The doctor assured me that I could lie on my back with no pain. Unbelievable, but he was right. I never had any pain in my back. My other great fear was undergoing surgery that would take all day. I couldn’t believe that surgeons could be alert and do such intricate surgery for that length of time. I also feared being under anesthesia for such a long procedure. I felt bad that my husband and parents would be sitting around for the better part of a day worrying. In retrospect, they seemed to have had a worse time than I did.

When I awoke from the surgery, I really felt fine. I was given an IV drip with painkiller and I honestly never had a moment’s pain (in my back or my front). The most annoying part of the recovery was dealing with the drains. I had one under each arm and four in my back. They didn’t hurt, but were just uncomfortable and annoying to hide from my children. The drains under my armpits came out within a week, but the ones in my back stayed in for almost five weeks (not quite a record I’m told, but still unusually long). At first, I was afraid to look at my breasts, but when I got up the courage, I couldn’t believe how amazing they looked. Everyone who saw them, from the hospital staff to my girl friends, couldn’t believe what artists my surgeons were. The outcome truly looked like magicians must have done it. As for recovery, I was back at work six weeks later. My family and friends took great care of me for the first five weeks. They cooked for my family every night, drove my kids everywhere, brought me laxatives (that’s how you know who your real friends are)…you name it, they did it. You really find out how people feel about you at a time like this, and surprisingly, instead of feeling sad, scared and depressed, I felt very lucky... lucky to be alive, lucky to have an excellent prognosis, and especially blessed to have such a wonderful support system.

I recently underwent my second surgery to remove my expanders and put in my implants. I was fine the next day and never needed a painkiller. I’m very happy so far with the outcome… my breasts look and feel natural. My back is still a little tender, but is healing nicely. I feel like I won lotto when I was referred to this plastic surgeon!

 

Photos and Doctor Commentary
 

Pre-operative bilateral mastectomies and latissimus flaps

Pre-operative

 

Pre-operative markings for bilateral mastectomies and latissimus flaps  images/PersonalStories/Pre-operative markings for bilateral mastectomies and latissimus flaps

Pre-operative markings for bilateral mastectomies and latissimus flaps

Laura 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.

 

 Post-operative bilateral mastectomies and latissimus flaps

Post-operative bilateral mastectomies and latissimus flaps Post-operative bilateral mastectomies and latissimus flaps

bilateral skin sparing mastectomies silicone implant bilateral skin sparing mastectomies silicone implant 

Post-Operative

Early after bilateral skin-sparing mastectomies with latissimus flap and silicone gel implant breast reconstruction. Scroll down to see Laura one year after her nipple reconstruction surgery.

 

healing latissimus flap donor scar

Healing 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.

 

 completed bilateral mastectomies

completed bilateral mastectomies and latissimus flaps bilateral mastectomies nipples reconstruction

  bilateral mastectomies reconstrution side view   

Completed bilateral latissimus flap breast reconstruction

This is Laura's final breast reconstruction two years after her mastectomies and one year after her nipple reconstruction and nipple tattoo. The silicone gel implants remain soft and well positioned. She has a very natural breast shape as a result of the latissimus flaps. The back skin island has allowed for improved central breast projection and excellent quality nipple reconstruction. The nipple tattoos complete the reconstruction and provide a very natural color tone.

 

latissimus flaps healed scars bilateral mastectomies

Fully healed latissimus flap donor scar