LD Flap Breast Reconstruction

The Latissimus Dorsi Flap (LD Flap) is a pedicle muscle flap that can be used for breast reconstruction. This means that the blood vessels supplying the ‘flap’ of muscle and overlying skin remain attached to the body and continue to supply the flap in the same way when it is moved to the breast site. This procedure involves taking either a portion or the whole of the latissimus dorsi muscle from your back and rotating it around to your front to create, or help create, a breast mound. The flap remains attached to its donor site, leaving blood supply intact.

The latissimus muscle is a fan-shaped muscle that originates from the shoulder and extends into the back area. It does not have any function related to the back, but it does act on the shoulder as an accessory muscle. However, there are other muscles in the rotator cuff area that assume the function of the latissimus dorsi for normal activities.

For a thin patient with small breast volume, the LD flap can be used alone as the primary reconstruction. However, sometimes an implant is used when the muscle isn’t large enough to produce the desired size, in these cases the LD Flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone. Usually, at first an adjustable tissue expander is used, it can be filled more when the tissue has healed after the mastectomy. The tissue expander can eventually be replaced by a silicone gel implant, which has a more natural feel. The LD Flap can also be used to help reconstruct partial mastectomy defects.

You are an ideal candidate for LD Flap Reconstruction if you:

  • Are thin with a small breast volume
  • Desire a more natural appearance than that of an implant alone
  • Have excess tissue laterally and upward across the mid-back
  • Are having a partial breast reconstruction in order to correct a lumpectomy defect
  • Have thin skin that requires extra coverage for an implant
  • Have been previously radiated and are having an implant reconstruction
  • Are having immediate or delayed reconstruction
  • Are not a candidate for other autologous procedures

You are NOT an ideal candidate if you:

  • Do not wish to have additional scarring to a part of the body other than the breasts
  • Have had previous chest-wall surgery such as a thoracotomy
  • Participate in extreme competitive sports such as mountain climbing, skiing, and swimming
  • Are a smoker or quit smoking only recently
  • cannot tolerate anaesthesia for long periods

LD Flap is particularly useful in immediate reconstruction, as a circle of skin, the same size as the mastectomy hole can also be moved, allowing the surgeon to close all wounds without stretching or distorting the remaining natural breast skin. It also results in only one circular scar on the breast, around the nipple

The procedure generally takes anywhere from two to three hours to complete, and is performed under general anaesthetic. Scars from this type of reconstruction are relatively discreet. In addition to the breast scar, there is a scar on the back, which can be almost horizontal and can be hidden under a bra-strap, or almost vertical under and just behind the armpit.

Dr Rezai and his team are highly experienced in the advanced microsurgical perforator flap procedures. They will will opt for this surgery only in the rare event that your anatomy does not allow for the DIEP or SIEP flap to be performed.

A few months after the breast reconstruction procedure, if it was removed with mastectomy, restoration of the nipple and areola will follow. The shape of the breast may also be refined to be more symmetrical with your untreated breast. For many patients the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts.

Advantages

  • Reliable blood supply to reconstructed breast
  • Good symmetry and cosmetic result for small to medium volume breasts
  • Faster recovery than abdominal-based flaps
  • Fewer long-term complications and re-operations
  • No abdominal weakness after surgery
  • Provides skin to replace the nipple area in immediate reconstruction to allow only a single, circular breast scar around the nipple
 Disadvantages

  • Usually only suitable for up to B cup breasts
  • Most women will need an implant in addition to the muscle flap
  • Skin colour and breast texture is not as natural as abdomen-based reconstruction
  • Longer recovery after surgery than for procedures that do not sacrifice muscle.
  • Muscle weakness can affect people who rely heavily on back or shoulder strength (swimmers, rock climbers, golfers, tennis players, etc.)
  • May need further small procedures to re-shape breast

Risks & Complications

All patients must understand and accept that no surgical procedure is absolutely free from risk. For further information concerning the risks and complications associated with Autologous Breast Reconstruction, please refer to Risks and Complications of Autologous Breast Reconstruction.

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