Breast reconstruction with latissimus dorsi flap

A breast reconstruction is an operation to recreate a breast shape after you have had a mastectomy. Your surgeon will use the latissimus dorsi muscle from the side of your back and usually an implant to recreate a breast shape (see figure 1).

Breast reconstruction with latissimus dorsi flap 

What are the benefits of a breast reconstruction with latissimus dorsi flap?

If the operation is successful, you will have a breast shape again. Using tissue from your body will give your reconstructed breast a more natural shape and feel.

Are there any alternatives to a breast reconstruction with latissimus dorsi flap?

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It may be possible to have a reconstruction using only an implant.

It may also be possible to use tissue from elsewhere in your body. You will not usually need an implant for this type of reconstruction.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes four to six hours. Your surgeon will make an elliptical cut in your back along the natural creases of your skin, and a cut in your breast or in the front of your chest. They will move the latissimus dorsi muscle around to the front of your chest and use it to create a breast shape. If you need an implant, your surgeon will create a pocket under the muscle to place the implant in.

What kind of breast implant should I choose?

All implants are made of an outer layer (shell) of silicone. They can be filled with silicone, salt water (saline) or both. The silicone used to fill the implant can be in the form of a liquid or gel (cohesive silicone). Liquid silicone and saline implants give a softer and more natural feel. Cohesive silicone implants give a firmer feel and can come in more shapes, so they are often recommended to women who are having breast reconstruction.

If you do not have enough skin or you have already had a mastectomy, your surgeon may need to use an expandable implant.

Is silicone safe?

Many studies have been carried out to find if silicone breast implants are safe. There is no evidence to suggest that women who have silicone breast implants are at a higher risk of getting diseases such as cancer and arthritis.

What complications can happen?

1. General complications of any operation

  • Pain
  • Bleeding
  • Unsightly scarring
  • Blood clots
  • Infection of the surgical site (wound)

2. Specific complications of this operation

a. Breast reconstruction complications

  • Developing a lump under the wound
  • Loss of the flap
  • Skin necrosis
  • Unnatural movement or twitching of the reconstructed breast
  • Difference in shape and appearance
  • Numbness or persistent pain around the armpit or the inner part of the arm
  • Permanent numbness around the scar in the back and on most of the surface of the reconstructed breast
  • Stiff shoulder
  • Arm weakness

b. Implant complications

  • Developing a collection of fluid in the pocket where the implant is
  • Infection of the implant
  • Thickening and tightening of the capsule
  • Kinking and rippling
  • Rupture or deflation of the implant

How soon will I recover?

You should be able to go home after four to seven days. Most women return to normal activities within four to six weeks.

Wearing a soft bra that fits comfortably will help to relieve any discomfort. If you have a reconstruction on both sides, you may find it more difficult to lift or pull yourself up.

If you have an expandable implant, you will need to come back to the clinic regularly over the next few months so your surgeon can gradually fill the implant with fluid.

The shape of your reconstructed breast will take several weeks to settle down. It can take up to a year for your reconstructed breast to feel part of you.

Summary

A breast reconstruction with latissimus dorsi flap is a cosmetic operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.

Paying for your procedure

Breast reconstruction with latissimus dorsi flap costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own procedure the cost will be explained and confirmed in writing when you book the procedure. Ask the hospital for a quote, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.

Copyright © 2010 Nucleus Medical Art.   This information is produced by EIDO Healthcare Ltd and is licensed by BMI Healthcare.

You may not copy, print out, download or otherwise reproduce any of the information other than for your personal, non-commercial use.

The information should not replace advice that your relevant health professional would give you.

Acknowledgements

Author: Mr Graham Offer BSc FRCS (Plast), Mr Eoin O' Broin MD FRCS (Plast), Mr Paul Roblin MSc FRCS (Plast) and Miss Kalliope Valassiadou MD, Consultant Breast and General Surgeon

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