Latissimus Flap Reconstruction

Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. In these cases, breast reconstruction usually requires a flap technique (also known as autologous reconstruction). A woman may also choose not to have an implant for personal reasons.
The latissimus flap, which is rotating the latissimus dorsi muscle and skin from the back bra-line area to the anterior chest, is most commonly used in the setting of radiation therapy or after a large radical mastectomy. The surgery time is shorter and a hospital stay is overnight rather than several days, when compared with abdominal tissue reconstruction. By bringing in healthy, non-radiated tissue to the breast, it allows tissue expanders or implants to stretch the breast pocket and offer a better final breast shape. This can reduce issues related to radiation-induced capsular contracture or tightening of the scar tissue and skin around the implant which may lead to pain, breast asymmetry, or deformity.

At her Atlanta office, board-certified plastic surgeon, Dr. Lindsey Webb, routinely performs latissimus flap reconstruction on women who have undergone a mastectomy. Using this surgical procedure, Dr. Webb can construct a new, natural-looking breast for better symmetry.

Latissimus flap surgery is often the first step in the reconstructive process, often with a tissue expander to help stretch out the skin to build or maintain an appropriate breast shape, and then subsequent procedures such as breast implant placement, fat grafting or nipple-areolar complex reconstruction or 3D tattoo, may be performed if indicated. Dr. Webb will be able to determine when these additional reconstructive steps can be scheduled.

Latissimus dorsi flap reconstruction utilizes skin and muscle from the back, which is tunneled just under the skin to the reconstructed breast. The flap stays connected to its donor site, leaving blood supply intact. Because the back has less fatty tissue than the abdomen, an implant is generally necessary to achieve the desired breast size, but not always. In most cases, this means a tissue expander will be placed initially at the time of surgery. Similar to tissue expander reconstruction alone, expansions usually begin two after your initial surgery until the desired size has been reached. At that point, a second, much less involved, surgery is performed to exchange the tissue expander for a permanent implant.

Latissimus flap surgery requires a one-night hospital stay immediately following surgery. It can take about six weeks before Dr. Webb releases you to full exercise and heavy lifting, but light walking begins immediately. Following surgery, it is important to take the time you need to heal. Dr. Webb will advise you when it is safe to start stretching exercises and normal activities. A short course of physical therapy with a qualified breast cancer physical therapist may be suggested to strengthen and maintain range of motion in your shoulder, if needed. Drains are placed for a short period to ensure fluid collections don’t develop. You will have a soft, supportive bra after surgery to help with swelling.

Latissimus dorsi flap breast reconstruction may not be appropriate for everyone. If Dr. Webb determines the latissimus flap technique is the right procedure for you, she will work with you to design a surgical plan that will fit your needs.