Latissimus Dorsi Flap
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. In a latissimus dorsi flap procedure, an oval flap of skin, fat, muscle, and blood vessels from your upper back is used to reconstruct the breast. 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.
While the skin on your back usually has a slightly different color and texture than breast skin, latissimus dorsi flap breast reconstruction can look 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 for a number of different reasons, such as:
There’s not enough donor tissue in the abdomen.
They’ve had previous flaps that failed and need a secondary alternative.
They don’t have access to plastic surgeons who can perform the microsurgery that free flaps require.
The latissimus dorsi flap may be a good option for women with small- to medium/small-sized breasts because there's usually not much fat on this part of the back. In most cases, a breast implant has to be placed under the flap to achieve the desired shape, size, and projection. 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.
While the latissimus dorsi flap may 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. So it’s generally not a good choice for bilateral reconstruction, because you could then have muscle issues on both sides.
Most women need an implant along with a latissimus dorsi flap, and 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.
Latissimus dorsi flap reconstruction: 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 is 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.
After latissimus dorsi flap reconstruction surgery: You'll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. If you're in pain or feel nauseated from the anesthesia, tell someone so you can be given medication.
You'll then be admitted to a hospital room. For a latissimus dorsi flap, you usually stay in the hospital for about 4 days.
Your doctor will give you specific instructions to follow for your recovery. For detailed information on what to expect after mastectomy and/or reconstruction surgery, including how to care for the dressings, stitches, staples, and surgical drains, visit the Mastectomy: What to Expect page.
It can take about 4 weeks to recover from latissimus dorsi reconstruction 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. You also may be healing from axillary node dissection (an incision under your arm where lymph nodes were removed) if your doctor recommended it.
It's important to take the time you need to heal. Follow your doctor's advice on when to start stretching exercises and your normal activities. You usually have to avoid lifting anything heavy, strenuous sports, and sexual activity for about 4 weeks after latissimus dorsi flap reconstruction. It’s worth having a short course of physical therapy with a qualified breast cancer physical therapist to strengthen and maintain range of motion in your shoulder. Ask your doctor for recommendations.
Latissimus dorsi flap surgery risks
Like all surgery, latissimus dorsi flap surgery has some risks. Many of the risks associated with latissimus dorsi flap surgery are the same as the risks for mastectomy. If you've had an implant inserted along with latissimus dorsi reconstruction, there are also risks unique to implant reconstruction. However, there are some risks that are unique to latissimus dorsi flap reconstruction.
Tissue breakdown: In rare instances, the tissue moved from your back to your breast area won't get enough circulation and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include the skin turning dark blue or black, a cold or cool-to-the-touch feeling in the tissue, and even the eventual development of open wounds. You also may run a fever or feel sick if these symptoms are not addressed immediately. If a small area of necrosis is found, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia or occasionally in a minor procedure setting. If most or all of the flap tissue develops necrosis, your doctor may call this a “complete flap failure,” which means the entire flap would need to be removed and replaced. Sometimes the flap can be replaced within a short timeframe, but in most cases the surgical team will remove all the dead tissue and allow the area to heal before identifying a new donor site to create a new 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 and persistent, talk to your doctor to see if you can work with a physical therapist on these issues. Also, ask about exercises you can do to help strengthen the area.
— Last updated on February 9, 2022, 8:32 PM